腹腔镜经腹逆向引导下内镜十二指肠乳头切开术501例报道  

Application of Transabdominal Reverse Guided-Laparoscopic Endoscopic Sphincteropa Pillotomy: A Report of 501 Cases

作　　者：陈安平[1] 高原[1] 李华林[1] 胡铤 索运生[1] 刘进衡 张胜龙[1] 刘安[1] 易斌[1] 

机构地区：[1]成都市第二人民医院肝胆胰外科,四川成都610017

出　　处：《中国普外基础与临床杂志》2016年第6期710-714,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨在腹腔镜胆总管探查术中采用经腹逆向引导技术施行内镜乳头切开术（laparoscopic endoscopic sphincteropa pillotomy,LEST）治疗十二指肠乳头狭窄的手术方法和适应证。方法回顾性分析2003年3月至2015年7月期间于成都市第二人民医院接受LEST治疗的501例十二指肠乳头狭窄患者的临床资料。结果 501例患者均顺利度过手术,无手术死亡。手术时间为60～190 min,平均107 min;术中出血量为5～100 mL,平均21.8 mL;术后住院时间为4～9 d,平均6.7 d。所有患者均成功切除胆囊,经腹腔镜胆总管探查取净胆总管结石493例（98.4%）,6例（1.2%）乳头切开成功后因胆总管残留结石置T管引流,术后经胆管镜和液电碎石取净;一期缝合术后发现残留结石2例（0.4%）。364例（72.7%）患者乳头狭窄切开成功后施行直接一期缝合术,9例（1.8%）留置输尿管导管后施行一期缝合术,118例（23.5%）留置鼻胆管后施行一期缝合术,4例（0.8%）乳头狭窄切开失败者和6例（1.2%）乳头切开成功后因胆总管残留结石者中转为T管引流术。术后发生轻症胰腺炎9例（1.8%）,发生胆汁漏23例（4.6%）,无肠穿孔、胆管穿孔、大出血、重症胰腺炎等并发症发生,术后总并发症发生率为6.8%（34/501,包括2例残留结石）。结论只要病例选择合适,在腹腔镜胆总管探查术中采用经腹逆向引导技术施行LEST是可行、有效和安全的。Objective To explore the operation methods and indications of the transabdominal reverse guidedlaparoscopic endoscopic sphincterotomy in treatment of duodenal papilla stenosis during the course of laparoscopic common bile duct exploration. Methods The clinical data of 501 cases of duodenal papilla stenosis who underwent laparoscopic endoscopic sphincterotomy with the transabdominal reverse guide technique from March 2003 to July 2015 in The Second People＇s Hospital of Chengdu City were analyzed retrospectively. Results All operation of the 501 cases were successful, no death happened. The operation time were 60-190 min（average of 107 min）, the blood loss were 5-100 m L（average of 21.8 m L）, and postoperative hospitalization time were 4-9 days（average of 6.7 days）. It was successful in 501 cases that removed the gallbladder, and successful in 493 cases（98.4%） that removed the common bile duct stones out of 501 cases. Six cases（1.2%） had residual stones in T tube drainage and received treatment with postoperative choledochoscope and electrohydraulic lithotripsy. Two cases（0.4%） of primary suture had residual stones. In the 501 cases, 364 cases（72.7%） underwent directly implementation of primary suture after the success of papillary stenosis cutting, 9 cases（1.8%） underwent primary suture after indwelling ureteral catheter, 118 cases（23.5%） underwent primary suture after detaining nasobiliary drainage, 4 cases（0.8%） failed in cutting the papillary stenosis and 6 cases（1.2%） had residual stones, all the 10 cases turned into the T tube drainage. After the operation, 9 cases（1.8%） suffered from mild pancreatitis and 23 cases（4.6%） suffered from bile leakage, no perforation of intestine and bile duct, bleeding, severe pancreatitis, and other complications happened. The overall incidence of postoperative complication was 6.8%（34/501）. Conclusion If patients are suitable, transabdominal reverse guided-laparoscopic endoscopic sphincterotomy in treatment of duodenal

关 键 词：十二指肠乳头狭窄 内镜乳头切开术 经腹逆向引导技术 

分 类 号：R657.4[医药卫生—外科学]