腹腔镜术中输尿管导管引导下内镜乳头切开术治疗胆囊结石合并细径胆总管结石的临床疗效(1)
摘要：目的 探讨腹腔镜胆囊切除术中输尿管导管引导下内镜十二指肠乳头切开术(EST)治疗胆囊结石合并细径胆总管结石的手术方法和适应证。方法 回顾性分析成都市第十一人民医院2009年3月～2016年2月施行同期LC+输尿管导管引导下EST治疗559例胆囊结石合并细径胆总管结石的临床资料。结果 559例顺利完成手术，无中转开腹，无死亡病例。手术时间平均(89.0±17.0)min；术中出血量5～20 ml，平均(11.2±3.4)ml。术后发生轻症胰腺炎9例(1.60%)，经保守治愈，残余结石1例，再次内镜下手术治愈。无胆漏、肠穿孔、胆管穿孔、大出血、重症胰腺炎等并发症。术后无胰腺炎症状者在术后第3 d拔除鼻胆管；有胰腺炎症状者在腹痛症状缓解，开始进食时拔除鼻胆管。术后均从腹腔引流管引流出渗液约10～300 ml/d，于1～5 d后停止。多数病人术后第3～5 d拔除腹腔引流管。结论 只要病例选择合适，在腹腔镜胆囊切除术中采用输尿管导管引导下内镜乳头切开术安全、可行，能提高手术成功率，减少乳头的损害及胰腺炎发生。
关键词：腹腔镜胆囊切除术；内窥镜检查；胆石症
, 百拇医药
Abstract：Objective To investigate the guided endoscopic sphincterotomy of intraoperative ureteral catheter in laparoscopic cholecystectomy(EST) surgical treatment of gallbladder stone with small diameter of common bile duct stones and indications.Methods A retrospective analysis of Eleventh People's Hospital of Chengdu city in March 2009～2016 February underwent LC+ureteral catheter guided EST treatment of 559 cases of gallbladder stones with small diameter of common bile duct stones.Results 559 cases were successfully completed the operation，no conversion，no deaths.The average operation time was(89±17)min；intraoperative blood loss was 5～20 ml，average(11.2±3.4)ml.Postoperative mild pancreatitis in 9 cases(1.60%)， the conservative cure，1 case of residual stones，re-endoscopic surgery was cured.No bile leakage，intestinal perforation bile duct perforation，bleeding， severe pancreatitis and other complications.Postoperative non-pancreatitis symptoms in the first 3 d after the removal of the nasal bile duct；symptoms of pancreatitis in abdominal pain relief，began to eat when the removal of nasal bile duct.After surgery from the peritoneal drainage tube drainage effusion about 10～300 ml/d，after 1～5 d to stop.Most patients after the first 3～5 d removal of abdominal drainage tube.Conclusion As long as the case selection is appropriate， laparoscopic cholecystectomy with ureteral catheter guided endoscopic papillary incision is safe and feasible，can improve the success rate of surgery to reduce the damage of the nipple and pancreatitis.
, 百拇医药
Key words：Laparoscopic cholecystectomy；Endoscopy；Cholelithiasis
隨着腹腔镜、内镜技术的发展，胆囊结石合并胆总管的治疗取得了重大突破，从传统的开腹手术发展到腹腔镜微创手术，从传统的胆道探查取石发展到LC+术前、术中、术后内镜十二指肠乳头括约肌切开取石术(endoscopic sphincterotomy，EST)。笔者单位开展了腹腔镜胆囊切除术中输尿管导管引导下内镜十二指肠乳头切开术(EST)治疗胆囊结石合并细径胆总管结石，并取得了较好的疗效。现报道如下。
1 资料与方法
1.1一般资料 559例患者，男264例，女295例。年龄13～89岁，平均52岁。195例(34.9%)有不同程度的黄疸。择期手术433例，急诊手术126例，磁共振胆胰管造影(magnetic resonance cholangiopancreatography，MRCP)提示乳头有狭窄者113例(20.2%)，胆总管结石数量约1～60余枚。术前诊断：依据超声，MRCP等。, 百拇医药(王绍勇 陈安平 李华林)
关键词：腹腔镜胆囊切除术；内窥镜检查；胆石症
, 百拇医药
Abstract：Objective To investigate the guided endoscopic sphincterotomy of intraoperative ureteral catheter in laparoscopic cholecystectomy(EST) surgical treatment of gallbladder stone with small diameter of common bile duct stones and indications.Methods A retrospective analysis of Eleventh People's Hospital of Chengdu city in March 2009～2016 February underwent LC+ureteral catheter guided EST treatment of 559 cases of gallbladder stones with small diameter of common bile duct stones.Results 559 cases were successfully completed the operation，no conversion，no deaths.The average operation time was(89±17)min；intraoperative blood loss was 5～20 ml，average(11.2±3.4)ml.Postoperative mild pancreatitis in 9 cases(1.60%)， the conservative cure，1 case of residual stones，re-endoscopic surgery was cured.No bile leakage，intestinal perforation bile duct perforation，bleeding， severe pancreatitis and other complications.Postoperative non-pancreatitis symptoms in the first 3 d after the removal of the nasal bile duct；symptoms of pancreatitis in abdominal pain relief，began to eat when the removal of nasal bile duct.After surgery from the peritoneal drainage tube drainage effusion about 10～300 ml/d，after 1～5 d to stop.Most patients after the first 3～5 d removal of abdominal drainage tube.Conclusion As long as the case selection is appropriate， laparoscopic cholecystectomy with ureteral catheter guided endoscopic papillary incision is safe and feasible，can improve the success rate of surgery to reduce the damage of the nipple and pancreatitis.
, 百拇医药
Key words：Laparoscopic cholecystectomy；Endoscopy；Cholelithiasis
隨着腹腔镜、内镜技术的发展，胆囊结石合并胆总管的治疗取得了重大突破，从传统的开腹手术发展到腹腔镜微创手术，从传统的胆道探查取石发展到LC+术前、术中、术后内镜十二指肠乳头括约肌切开取石术(endoscopic sphincterotomy，EST)。笔者单位开展了腹腔镜胆囊切除术中输尿管导管引导下内镜十二指肠乳头切开术(EST)治疗胆囊结石合并细径胆总管结石，并取得了较好的疗效。现报道如下。
1 资料与方法
1.1一般资料 559例患者，男264例，女295例。年龄13～89岁，平均52岁。195例(34.9%)有不同程度的黄疸。择期手术433例，急诊手术126例，磁共振胆胰管造影(magnetic resonance cholangiopancreatography，MRCP)提示乳头有狭窄者113例(20.2%)，胆总管结石数量约1～60余枚。术前诊断：依据超声，MRCP等。, 百拇医药(王绍勇 陈安平 李华林)
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