腹腔镜胆总管探查术联合球囊导管扩张治疗肝内胆管狭窄的疗效及安全性  

Efficacy and safety of laparoscopic common bile duct exploration combined with balloon catheter dilation in the treatment of intrahepatic bile duct strictures

作　　者：丁峰 宋贤超 任同良 李传海 郑立忠 刘惠君 Ding Feng;Song Xianchao;Ren Tongliang;Li Chuanhai;Zheng Lizhong;Liu Huijun(Department of General Surgery,the Fourth People’s Hospital of Shangqiu,Shangqiu 476100,China)

机构地区：[1]商丘市第四人民医院普外科,商丘476100 [2]商丘市第四人民医院急诊外科,商丘476100

出　　处：《中国实用医刊》2022年第10期31-34,共4页Chinese Journal of Practical Medicine

摘　　要：目的探讨腹腔镜胆总管探查术(LCBDE)联合球囊导管扩张治疗肝内胆管狭窄的疗效及安全性。方法回顾性分析2019年7月至2021年6月商丘市第四人民医院收治的62例肝内胆管结石合并肝内胆管狭窄患者的临床资料,所有患者均接受LCBDE联合球囊导管扩张治疗。评估患者围术期相关指标、手术前后实验室指标[血清丙氨酸氨基转氨酶(ALT)、天门冬氨酸氨基转移酶(AST)、淀粉酶、直接胆红素(DBIL)、白细胞计数(WBC)和降钙素原(PCT)],记录患者术后恢复情况及并发症发生情况。结果62例患者均顺利完成手术,手术时间80~120(98.78±10.25)min;术中失血量40~85(58.49±11.85)ml;术中均无胆道出血、胆汁瘤等并发症,围术期无死亡病例。术后3 d,患者血清ALT、AST、DBIL、WBC和PCT水平均较术前下降,血清淀粉酶较术前升高(P<0.05)。患者术后胃肠道功能恢复时间为0.5~5.0(2.76±1.13)d,鼻胆管拔除时间为2~8(5.67±1.25)d,住院时间为5~12(8.24±1.36)d。随访期间,21例(33.87%)患者术后出现腹痛腹胀、恶心呕吐等消化道症状,10例(16.13%)患者术后并发急性胰腺炎,3例(4.84%)患者发生胆漏,9例(14.52%)患者结石复发,无胆管再度狭窄及胆管炎发生。结论LCBDE联合球囊导管扩张治疗肝内胆管狭窄具有良好疗效,可安全有效地解除肝内胆管狭窄,术后并发症较少,有利于患者恢复。Objective To investigate the efficacy and safety of laparoscopic common bile duct exploration(LCBDE)combined with balloon catheter dilation in the treatment of intrahepatic bile duct strictures.Methods The clinical data of 62 patients with intrahepatic bile duct stones complicated by intrahepatic bile duct strictures who were admitted to the Fourth People’s Hospital of Shangqiu from July 2019 to June 2021 were retrospectively analyzed.All patients were treated by LCBDE combined with balloon catheter dilation.The related perioperative indicators,preoperative and postoperative laboratory indicators,including serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),amylase,direct bilirubin(DBIL),white blood cell count(WBC)and procalcitonin(PCT)were evaluated,and postoperative recovery and complications were recorded.Results All of the 62 patients underwent operation successfully.The operation time and blood loss were 80-120(98.78±10.25)min and 40-85(58.49±11.85)ml,respectively.No intraoperative complication(hemobilia and biloma)was found during operation,and none of them dead in perioperative period.The levels of serum ALT,AST,DBIL,WBC and PCT were reduced,and serum amylase was increased 3 days after operation(P<0.05).The postoperative recovery time of gastrointestinal function,time of nasobiliary tube removal and length of hospital stay were 0.5-5.0(2.76±1.13)days,2-8(5.67±1.25)days and 5-12(8.24±1.36)days,respectively.There were 21(33.87%)patients with gastrointestinal symptoms such as abdominal pain,abdominal distension,nausea and vomiting,10(16.13%)patients with acute pancreatitis,3(4.84%)patients with bile leakage,and 9(14.52%)patients with recurrent stones during follow-up.No bile duct re-stricture or cholangitis was found.Conclusions LCBDE combined with balloon catheter dilation is effective in the treatment of intrahepatic bile duct strictures.The treatment can safely and effectively relieve intrahepatic bile duct strictures,with fewer postoperative complications,which is conducive to the r

关 键 词：肝内胆管结石 肝内胆管狭窄 腹腔镜胆总管探查术 球囊导管扩张 临床疗效 

分 类 号：R657.4[医药卫生—外科学]