微创治疗非扩张性肝外胆管结石230例临床分析  

Clinical analysis of mini-invasive treatment for gallstone with non-dilated extrahepatic choledocholithiasis,experiences in 230 patients

作　　者：赵亮[1] 蒋超[1] 孙大伟[1] 王蒙[1] 吕国悦[1] 王广义[1] Zhao Liang;Jiang Chao;Sun Dawei;Wang Meng;Lyu Guoyue;Wang Guangyi(Department of Hepatobiliary Pancreatic Surgery,First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院肝胆胰外一科,长春130021

出　　处：《中华普通外科杂志》2020年第7期521-523,共3页Chinese Journal of General Surgery

基　　金：吉林省卫生厅基金资助项目(2016J058)。

摘　　要：目的探讨非扩张性肝外胆管结石的微创治疗方法和效果.方法收集2015年10月至2018年12月胆囊结石合并非扩张性(胆总管直径≤8 mm)胆总管结石患者230例,治疗方法包括内镜胰胆管逆行造影术(ERCP)+同步腹腔镜胆囊切除术(LC)、ERCP+二期LC、腹腔镜联合胆道镜经胆囊管胆道探查取石术(LTCBDE),比较不同方法的优势及疗效.结果ERCP+同步LC 69例(69/70)取石成功,ERCP+二期LC 118例(118/120)胆管取石成功,LTCBDE 38例(38/40)取石成功.不同治疗方法的手术成功率差异无统计学意义(P>0.05);LTCBDE组平均术后住院时间最短(F=243.22,P=0.000)、平均住院费用最少(F=300.40,P=0.000)及并发症发生率最少(10.00%,P<0.05).结论微创治疗非扩张性肝外胆管结石适应证的合理选择至关重要,LTCBDE更值得临床推广应用.Objective To evaluate the methods and effects of mini-invasive treatment of non-dilated common bile duct stones.Methods From Oct 2015 to Dec 2018,clinical data of 230 cases of cholecystolithiasis combined with non-dilated common bile duct stones(choledochal diameter^8 mm)at our hospital were analyzed.The treatment methods included endoscopic retrograde cholangiopancreatography(ERCP)+synchronous LC,ERCP+nonsynchronous LC,laparoscopic transcyctic duct common bile duct exploration(LTCBDE).Results In 69 out of 70 patients in the ERCP+synchronous LC group stones were successfully extracted.In 118(118/120)cases out of the ERCP+nonsynchronous LC group common bile duct stones were successfully removed,LTCBDE was performed in 38(38/40)cases and stones were successfully removed.There was no significant difference in the success rate among the three methods(P>0.05),while patients in LTCBDE group had the shortest mean postoperative hospitalization time(F=243.22,P=0.000),the least average hospitalization cost(F=300.40,P=0.000)and with lower incidence of complications(10.00%,P<0.05).Conclusions It is of great importance to adopt the appropriate procedures for the mini-invasive treatment of non-dilated extrahepatic common bile duct stones.LTCBDE is the most suitable procedures for this purpose.

关 键 词：胆总管结石 胰胆管造影术 内窥镜逆行 腹腔镜 

分 类 号：R657.42[医药卫生—外科学]