经胆囊管切开胆总管在多镜联合治疗胆囊结石合并胆总管结石中的应用  

Application of transcholecystectomy of common bile duct in multiple endoscopy combined treatment of cholecysto-choledocholithiasis

作　　者：杨勇[1] 汪大海[1] 廖铂[2] 程志祥[2] 龚铖[2] 尹玉春[2] 江平[2] YANG Yong;WANG Dahai;LIAO Bo;CHENG Zhixiang;GONG Cheng;YIN Yuchun;JIANG Ping(Dept.of General Surgery,Huangmei People's Hospital,Huanggang 436500,Hubei,China;Dept.of Hepatobiliary and Pancreatic Surgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,Hubei,China)

机构地区：[1]黄梅县人民医院普外科,湖北黄冈436500 [2]武汉大学中南医院肝胆胰外科,湖北武汉430071

出　　处：《武汉大学学报（医学版）》2022年第2期286-289,共4页Medical Journal of Wuhan University

摘　　要：目的:探讨多镜联合经胆囊管汇入部切开胆总管治疗胆囊结石合并胆总管结石的临床效果。方法:对2018年6月—2020年12月收治的32例胆囊结石合并胆总管结石患者采用腹腔镜下联合胆道镜、十二指肠镜经胆囊管切开胆总管方法完成胆道探查取石一期缝合术的临床资料。结果:32例患者均顺利完成多镜联合经胆囊管切开胆总管取石一期缝合术,手术时间(124.38±21.65)min,术中出血量(25.94±9.18)mL。术后第1天淀粉酶(69.75±29.15)U/L,未出现术后胆漏、胰腺炎等并发症。术后一般第2天拔除鼻胆管,引流管酌情于术后3~4 d拔除。总住院时间(6.44±1.63)d。患者出院后均随访3个月,返院行肝功能、B超检查,未出现肝功能异常、胆总管结石残留等情况。结论:腹腔镜联合胆道镜、十二指肠镜经胆囊管切开胆总管进行胆道探查取石术具有恢复快、并发症少,具有可行性及安全性。Objective: To explore the clinical effect of transcholecystectomy of common bile duct in multiple endoscopy combined treatment of cholecysto-choledocholithiasis. Methods: We retrospectively analyzed the clinical data of 32 patients with cholecysto-choledocholithiasis from January 2018 to December 2020 in this study. Patients were treated by laparoscopic combined with choledochoscope and duodenoscope transcystic common bile duct exploration, and primary closure of the common bile duct.Results: All 32 cases were performed operation successfully. The operation time was(124. 38±21. 65)min, intra-operative bleeding volume was(25. 94±9. 18)mL, and blood amylase level of the first day after operation was(69. 75±29. 15)U/L. No complications such as biliary tract bleeding and pancreatitis occurred. All cases were placed abdominal cavity drainage tube and nasal bile duct.The nasal bile ducts were pull out after 2 days in most cases, and abdominal cavity drainage tube were pulled out after 3 or 4 days. The hospitalization time was(6. 44±1. 63)d. All patients were followed up for 3 months. No common bile duct stones were found by ultrasonography, and liver function was normal. Conclusion: Transcholecystectomy of common bile duct in multiple endoscopy combined treatment of cholecysto-choledocholithiasis has positive clinical efficacy with short recovery time and less complications, and it was uncomplicated for doctors and safe for the patients with cholecystocholedocholithiasis.

关 键 词：胆囊结石合并胆总管结石 腹腔镜 胆道镜 十二指肠镜:经胆囊管胆总管切开 

分 类 号：R657.42[医药卫生—外科学]