序贯治疗胆总管结石合并胆囊结石伴急性胆管炎的疗效分析  

PTCD combined with laparoscopic common bile duct exploration and primary duct closure in treating patients presenting with acute cholangitis due to common bile duct stones

作　　者：丁雪梅 王向涛 孔新亮 李尚胜 高君[4] 柯山 王劭宏[4] 孔健[4] 周意明[5] 李强 孙文兵[4] Ding Xueme;Wang Xiangtao;Kong Xinliang;Li Shangsheng;Gao Jun;Ke Shan;Wang Shaohong;Kong Jian;Zhou Yinming;Li Qiang;Sun Wenbing(Physical Examination Center,Beijing Shijitan Hospital Affiliated to Capital Medical University,Beijing 100038,China;Department of Hepatobiliary Surgery,the Second People's Hospital of Binzhou,Binzhou 256800,Shandong Province,China;Department of General Surgery,Rizhao Central Hospital,Rizhao 276800,Shandong Province,China;Department of Hepatobiliary-pancreatic-splenic Surgery,West Campus,Beijing Chaoyang Hospital Affiliated to Capital Medical University,Beijing 100043,China;Department of Interventional Radiology,West Campus,Beijing Chaoyang Hospital Affiliated to Capital Medical University,Beijing 100043,China)

机构地区：[1]首都医科大学附属北京世纪坛医院健康体检中心,北京100038 [2]滨州市第二人民医院肝胆外科,山东滨州256800 [3]山东省日照市中心医院普通外科,山东日照276800 [4]首都医科大学附属北京朝阳医院西院肝胆胰脾外科,北京100043 [5]首都医科大学附属北京朝阳医院西院介入放射科,北京100043

出　　处：《中华肝胆外科杂志》2021年第7期513-516,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：北京市石景山区医学重点学科建设项目(20130001)。

摘　　要：目的初步探讨序贯应用保守治疗、经皮经肝胆管引流(PTCD)、腹腔镜胆囊切除术(LC)+腹腔镜胆总管探查术(LCBDE)+一期胆管缝合(PDC)治疗胆总管结石(CBDS)合并胆囊结石伴急性胆管炎的临床应用价值。方法回顾分析2015年1月至2020年8月多中心CBDS合并胆囊结石伴急性胆管炎397例患者临床资料,包括首都医科大学附属北京朝阳医院西院230例、滨州市第二人民医院95例和日照市中心医院72例。序贯应用保守治疗、PTCD和LC+LCBDE+PDC进行治疗。分析PTCD至LCBDE时间间隔、PTCD后血清总胆红素和丙氨酸氨基转移酶(ALT)下降情况、LC+LCBDE+PDC手术时间、术中出血量等。术后腹腔引流管及PTCD管留置时间、术后住院时间、术后并发症等。结果入组患者33例,男性15例,女性18例,平均年龄57.5岁。经PTCD引流后,血清总胆红素从(148.3±36.8)μmol/L降至(32.6±5.9)μmol/L,ALT从(172.6±26.9)U/L降至(45.7±7.2)U/L,PTCD至LCBDE时间间隔(25.3±2.6)d。手术时间(95.4±14.2)min,术中出血量(35.2±9.5)ml,术后住院时间(12.4±3.5)d。腹腔引流管和PTCD管留置时间分别为(10.6±2.3)d和(25.8±4.7)d。术后发生胆瘘3例(9.1%)、腹腔出血1例(3.0%)、胆道出血1例(3.0%)、脐部切口感染1例(3.0%)、胆总管下端狭窄2例(6.1%),均经保守治疗后痊愈。结论序贯应用保守治疗、PTCD和LC+LCBDE+PDC治疗CBDS合并胆囊结石伴急性胆管炎是一种安全、有效和微创的方式,可作为内镜逆行胰胆管造影的替代,具有推广价值。Objective To study the results of using a sequential menagement of conservative treatment,percutaneous transhepatic cholangial drainage(PTCD),laparoscopic cholecystectomy(LC)combined with laparoscopic common bile duct exploration(LCBDE)and primary duce closure(PDC)in patients with cholecystolithiasis and common bile duct stone(CBDS)who presented with acute cholangitis.Methods The clinical data of 397 patients with CBDS and cholecystolithiasis who presented with acute cholangitis from January 2015 to August 2020 were retrospectively analyzed,including 230 patients from the West Campus,Beijing Chaoyang Hospital,Capital Medical University,95 patients from the Second People's Hospital of Binzhou and 72 patients from Rizhao Central Hospital.Conservative treatment,PTCD and LC+LCBDE+PDC were used sequentially.The interval between PTCD and LCBDE,the decrease of serum total bilirubin and alanine aminotransferase after PTCD,the operative time of LC+LCBDE+PDC,and the intraoperative blood loss were analyzed.Postoperative indwelling time of abdominal drainage tube and PTCD tube time,postoperative hospital stay,postoperative complications,etc.Results These were 15 males and 18 femals with the mean age of 57.5 years old.The mean serum total bilirubin and alanine aminotransferase levels decreased from(148.3±36.8)μmol/L and(172.6±26.9)U/L before PTCD to(32.6±5.9)μmol/L and(45.7±7.2)U/L after PTCD,respectively.The interval between PTCD and LCBDE was(25.3±2.6)d.The operation time of LC+LCBDE+PDC was(95.4±14.2)min.The intraoperative blood loss was(35.2±9.5)ml and the mean postoperative hospital stay was(12.4±3.5)d.The postoperative indwelling time of abdominal drainage tubes and PTCD tubes were(10.6±2.3)d and(25.8±4.7)d,respectively.After surgery,bile leakage occurred in 3 patients(9.1%),abdominal hemorrhage in 1 patient(3.0%),biliary bleeding in 1 patient(3.0%),navel incision infection in 1 patient(3.0%),lower common bile duct stenosis in 2 patients(6.1%).All complications responded well to conservation treatment.Conclu

关 键 词：胆总管结石病 经皮经肝胆管引流 胆道探查术 一期胆管缝合 

分 类 号：R657.4[医药卫生—外科学]