腹腔镜联合胆道镜在胰管结石治疗中的应用  

Application of laparoscopy combined with choledochoscope in the treatment of pancreatic duct stones

作　　者：朱兆璧 陈伟[1] 谢佳明[1] 高嘉伟 徐相蓉 张超 庄林俊 何晨馨 Zhu Zhaobi;Chen Wei;Xie Jiaming;Gao Jiawei;Xu Xiangrong;Zhang Chao;Zhuang Linjun;He Chenxin(Second Affiliated Hospital of Soochow University,Jiangsu 215000,China)

机构地区：[1]苏州大学附属第二医院肝胆胰外科,江苏215000

出　　处：《中华腔镜外科杂志（电子版）》2023年第3期171-174,共4页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的:探讨腹腔镜联合胆道镜在胰管结石治疗中的安全性及有效性。方法:回顾性分析2018年6月至2023年3月苏州大学附属第二医院肝胆胰外科采用腹腔镜联合胆道镜治疗的8例慢性胰腺炎合并胰管结石患者的临床数据,包括手术时间、术后住院天数、术中出血量、术后并发症发生情况、结石残留情况,疼痛缓解情况,血糖情况等。结果:8例中有一例术中探查发现胰腺癌伴肝转移,终止手术,其余7例均顺利完成腹腔镜联合胆道镜取石+钬激光碎石术+胰管空肠Roux-en-Y吻合术,统计胰管结石的直径(7.64±2.17)mm,胰管直径(8.8±2.80)mm。平均手术时间(222±67.5)min,平均术后住院天数(16±7.8)d。随访时间内(3~64)个月,6例患者的症状明显缓解,均未发生明显的腹痛;1例患者有急性胰腺炎发作史,发作频率较手术前明显降低;所有患者腹部CT未见明显结石复发。结论:腹腔镜联合胆道镜治疗慢性胰腺炎合并胰管结石是一种安全、有效的方法。Objective:To explore the safety and effectiveness of laparoscopy combined with choledochoscope in the treatment of pancreatic duct stones.Methods:Retrospective analysis of clinical data of 8 cases of chronic pancreatitis with pancreatic duct stones treated by laparoscopy combined with choledochoscope in the Department of Hepatobiliary and Pancreatic Surgery of the Second Affiliated Hospital of Soochow University from June 2018 to March 2023,including operation time,postoperative hospital stay,intraoperative bleeding,postoperative complications,residual stones,pain relief,blood sugar status,etc.Results:Among the 8 cases,one case of pancreatic cancer with liver metastasis was found during operation,and the operation was terminated.The other 7 cases successfully completed laparoscopy combined with choledochoscopy+holmium laser lithotripsy+Roux-en-Y pancreatojejunostomy.The diameter of pancreatic duct stones(7.64±2.17)mmand pancreatic duct diameters(8.8±2.80)mm were counted.The average surgical time(222±67.5)minutes and the average postoperative hospital stay(16±7.8)days.During the follow-up period(3-64)months,the symptoms of 6 patients were significantly relieved,and no significant abdominal pain occurred;One patient had a history of acute pancreatitis,with a significantly lower frequency of episodes compared to before surgery;All patients showed no obvious recurrence of stones on abdominal CT.Conclusion:Laparoscopy combined with choledochoscopy is a safe and effective method for the treatment of chronic pancreatitis with pancreatic duct stones.

关 键 词：腹腔镜 胆道镜 超细胆道镜 胰管结石 慢性胰腺炎 

分 类 号：R735.9[医药卫生—肿瘤]