腹腔镜胰管切开取石+胰管T管引流术在慢性胰腺炎合并胰管结石中的应用价值  

Application value of laparoscopic pancreatic duct lithotomy and pancreatic duct T drainage for chronic pancreatitis complicated with pancreatic duct stones

作　　者：吴波 俞世安 厉学民 吴晓康 龚道军[1] 许龙堂 Bo Wu;Shi-an Yu;Xue-min Li;Xiao-kang Wu;Dao-jun Gong;Long-tang Xu(Department of Hepatobiliary and Pancreatic Surgery,Jinhua Central Hospital(Jinhua Hospital,Zhejiang University School of Medicine),Jinhua,Zhejiang 321000,China)

机构地区：[1]金华市中心医院(浙江大学医学院附属金华医院)肝胆胰外科,浙江金华321000

出　　处：《中国内镜杂志》2022年第6期72-77,共6页China Journal of Endoscopy

基　　金：浙江省基础公益研究计划(No:LGF20H160028);金华市科技局重大专项(No:2018-3-001a)。

摘　　要：目的 探讨腹腔镜胰管切开取石+胰管T管引流术在慢性胰腺炎合并胰管结石中的应用价值。方法 回顾性分析2017年1月-2020年6月浙江大学医学院附属金华医院5例行腹腔镜胰管切开取石+胰管T管引流术治疗胰管结石的患者的临床资料。结果 5例患者均顺利完成手术。其中,1例Ⅳb型胰管结石予以EMS碎石清石系统碎石。手术时间120~180 min,平均145 min;术中出血量15~50 mL,平均29 mL;术后胃肠道功能恢复时间1.0~2.0 d,平均1.6 d;术后住院时间4.0~11.0 d,平均7.0 d;T管拔除时间32.0~60.0 d,平均42.4 d。术后无胰瘘、出血和腹腔感染等并发症发生。5例患者疗效均为优良。术后随访27.0~55.0个月,平均40.8个月。1例糖尿病患者胰岛素用量较术前减少;1例T管造影示胰管残余结石,行胆道镜检查术取出残余结石。患者均未见结石复发,无恶变。结论 腹腔镜胰管切开取石+胰管T管引流术创伤小,恢复快,疗效满意,操作简单,是一种安全有效的术式。Objective To investigate the application value of laparoscopic pancreatic duct lithotomy and pancreatic duct T drainage in treatment of chronic pancreatitis complicated with pancreatic duct stones. Methods Clinical data of patients underwent laparoscopic pancreatic duct lithotomy and pancreatic duct T drainage for pancreatic duct stones from January 2017 to June 2020 were retrospectively analyzed. Results All the 5 cases were successfully operated. Among of them, one case of Ⅳbtype pancreatic duct stone was treated with EMS lithotripsy system. The operative time was 120 ~ 180 min, with an average of 145 min;The intraoperative bleeding was15 ~ 50 m L, with an average of 29 mL;The postoperative gastrointestinal function recovery time was 1.0 ~ 2.0 d,with an average of 1.6 d;The postoperative hospital stay was 4.0 ~ 11.0 d, with an average of 7.0 d;The T tube removal time was 32.0 ~ 60.0 d, with an average of 42.4 d. No postoperative complications such as pancreatic leakage, bleeding and abdominal infection occurred. The follow-up time was 27.0 ~ 55.0 months, with an average of40.8 months. The insulin dosage of 1 diabetic patient was reduced compared with that before surgery. One patient showed residual pancreatic duct stones by T tube angiography, and the residual stones were removed by choledochoscopy. There was no recurrence of calculi and no malignant change. Conclusion Laparoscopic pancreatic duct lithotomy and pancreatic duct T drainage is a safe and effective operation with little trauma, quick recovery, satisfactory curative effect and simple operation.

关 键 词：胰管结石 胰管T管引流 腹腔镜 慢性胰腺炎 胆道镜 

分 类 号：R657.5[医药卫生—外科学]