腹腔镜联合胆道镜经胆囊管治疗胆囊结石合并胆总管结石的临床分析

目的探讨应用腹腔镜联合胆道镜经胆囊管行胆道探查治疗胆囊结石合并胆总管结石的临床效果。方法对2014年1月-2015年12月陕西省核工业二一五医院收治的52例胆囊结石合并胆总管结石患者行腹腔镜联合胆道镜经胆囊管胆道探查取石术,观察其临床效果。结果 52例患者中40例顺利完成手术,手术成功率为76.92%。7例改为腹腔镜下胆总管切开取石、T管引流术,5例中转开腹行胆总管切开取石、T管引流术,中转开腹率9.62%。43例患者一次取石成功,占82.69%;剩余9例患者行二次取石,其中行经胆囊管胆道探查取石术者8例,行腹腔镜下胆总管切开取石术者1例。所有患者术后留置网膜孔引流管,术后3~10 d拔除,1例行腹腔镜下胆总管切开取石患者术后出现胆漏,经保守治疗后康复。无胆道出血、胆道感染等发生,平均住院时间(8.24±2.52)d,所有患者均得到随访1年,B超及磁共振胰胆管造影检查肝内外未见结石残留,肝功能胆红素指标正常。结论腹腔镜联合胆道镜经胆囊管进行胆道探查取石术具有创伤小、患者恢复快、并发症少、安全等优点,临床应用需严格掌握其适应证。     

腹腔镜联合胆道镜经胆囊管取石治疗胆囊结石合并胆总管结石5年随访效果分析

背景胆囊结石合并胆总管结石的治疗方法有多种,当前较为常用的有腹腔镜下胆囊切除、胆总管探查术,内镜下乳头括约肌切开取石术加腹腔镜胆囊切除术,但前者因术后需放置T管引流、后者因破坏Oddi括约肌而有一定的争议.本研究经胆囊管途径取石,避免了损伤胆总管和Oddi括约肌切开所造成的损伤,在临床中取得了良好的效果.目的探讨腹腔镜下应用胆道镜经胆囊管取石治疗胆囊结石合并胆总管结石的临床效果.方法对2013-01/2013-12的成功实施腹腔镜联合胆道镜经胆囊管取石治疗胆囊结石合并胆总管结石的125例患者进行5年随访,分析其临床治疗效果.结果122例患者成功完成了腹腔镜胆囊切除加联合胆道镜经胆囊管胆总管取石术,手术成功率97.6%,平均年龄58.21岁±13.01岁,手术时间为87.95min±39.12min,术中出血11.27 mL±6.85 mL.所有患者均行球囊扩张,其中33例行胆囊管汇合处微切开, 5例行胆道镜下碎石术.患者术后排气时间为32.48 h±17.85 h.术后住院时间为2.03 d±1.62 d.短期随访并发症5.74%,共7例,其中术后胰腺炎4例,经奥曲肽、乌司他丁等对症治疗后治愈,发生胆漏2例,经ENBD引流后治愈,手术切口感染1例,经换药后治愈. 5年远期并发症4.92%,共6例,胆总管复发结石4例,其中1例合并肝内胆管结石,胰腺炎2例.死亡患者4名, 2例心梗, 1例肺部感染, 1例车祸,均与本手术无关.结论腹腔镜联合胆道镜经胆囊管取石治疗胆囊结石合并胆总管结石近期及远期效果较好,患者创伤小,恢复快,并发症少,在临床掌握适应证的前提下,值得推广.     

经胆囊管纤维胆道镜胆道探查的临床价值

胆囊结石合并胆总管结石或高度怀疑合并胆总管结石，传统多行胆囊切除、胆总管切开取石、T型管引流术，近年来，由于微创、内镜技术的发展，采用三镜联合（腹腔镜、十二指肠镜、纤维胆道镜）治疗日趋增多，但各有其优缺点。我院自2002年至2007年采用不切开胆总管、经胆囊管纤维胆道镜探查取石术，术后不放置T型管，共实施96例，其中证实结石并取出者62例，保持了胆道的完整性，对胆总管结石患者避免了胆总管切开后置T型管引流带来的不便和潜在的并发症，对胆总管无结石者避免了胆道探查带来的损伤，患者痛苦轻、恢复快、并发症少，取得了满意的疗效。     

胆道镜在胆道手术中的应用

目的探讨胆道镜在胆道手术中的应用价值.方法对经CT、B超、ERCP或MR证实为胆石症的32例胆道手术患者术中进行胆道镜探查,常规开腹切除胆囊或切开胆管将结石取出后,胆道镜经胆囊管残端或胆管切开处插入胆道依次探查左右肝管,肝总管、胆总管.结果32例患者中发现肝管残留结石1例,胆总管残留结石2例,胆总管末端狭窄2例,胆管癌1例.3例残留结石中2例以取石器将结石取出,1例结石嵌顿在乳头开口处,以胆道镜推送至十二指肠内.2例胆总管末端狭窄,给予胆道镜下扩张治疗,减轻了术后因胆总管末端狭窄而导致的不良后果.1例在探查中发现胆总管下端不光滑,有小结节状隆起,取组织病理检查证实为胆管癌而改变术式,避免了再次开腹手术.结论胆道手术时行胆道镜探查,可减少残留结石的发生,并能及时发现其他病理情况,给予相应治疗,减少漏误诊的发生.     

两种不同方法治疗胆囊结石并胆总管结石的临床疗效比较

目的比较腹腔镜下胆囊切除术+胆总管切开取石术和开腹胆囊切除术+胆总管切开取石术治疗胆囊结石并胆总管结石的临床疗效。方法将52例胆囊结石并胆总管结石患者按随机数字表法分为腹腔镜组和开腹组,各26例。腹腔镜组(26例)采用腹腔镜下胆囊切除术+胆总管切开取石术+术中胆道镜探查+T管引流术治疗;开腹组(26例)采用开腹胆囊切除术+胆总管切开取石术+术中胆道镜探查+T管引流术治疗,对比两组治疗效果。结果腹腔镜组手术时间长于开腹组,术后疼痛VAS评分、术后止痛药使用率、术后炎性因子[C反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子-α(TNF-α)]水平及术后肛门排气时间、术后住院时间等均低于或短于开腹组,差异均有统计学意义(P 0. 05)。结论腹腔镜下胆囊切除术+胆总管切开取石术创伤较小、应激较轻、术后恢复较快。     

腹腔镜联合胆道镜治疗胆管结石160例

目的:探讨腹腔镜联合胆道镜在胆总管切开取石中的应用方法及疗效.方法:回顾性分析1998-01/2006-12我院160例胆总管结石行胆总管探查、胆道镜取石的临床资料.结果:159例在腹腔镜下顺利完成手术,1例中转开腹.胆总管一期缝合68例,置T管92例,术中取尽结石156例,术后胆道镜取石4例.手术时间70-120(平均115)min,术后住院时间4-11(平均6)d.无胆道出血及腹腔感染,无手术死亡.术后胆漏2例.经再次腹腔镜下缝合与引流治愈.120例随访6-36(平均18)mo,无结石复发和远期并发症.结论:腹腔镜联合胆道镜胆总管探查取石术具有创伤小、恢复快、住院时间短的优点,治疗胆总管结石安全有效.     

老年胆石症患者腹腔镜胆总管切开取石一期缝合35例分析

目的探讨腹腔镜胆总管切开取石一期缝合治疗老年胆总管结石可行性及安全性。方法选取2009年12月至2012年8月行腹腔镜、纤维胆道镜联合治疗胆囊结石、胆总管结石,一期胆总管缝合≥65岁老年病人35例。完全腹腔镜下胆囊切除,联合胆总管切开通过胆道镜置入取石网篮取石,术毕一期缝合胆总管。结果本组腹腔镜胆道镜联合行胆总管探查取石术成功率为100%,手术时间57~170 min,出血量10~100 ml,术后住院时间5~10 d,发生胆漏2例,再次手术1例。术后随访4月至2年,残余胆总管结石1例。结论在严格把握手术指征,认真评价术前影像学,术中熟练胆道镜操作,精准缝合的前提下,老年病人腹腔镜胆总管切开取石一期缝合治疗胆总管结石是安全可行的。     

胆囊结石合并胆总管结石的现代外科治疗模式

微创化理念的迅速普及, 微创设备的高速发展, 外科医师可以熟练的运用各种微创化器械使患者在短期内迅速康复. 胆总管结石的治疗方式也发生了巨大变化, 由传统的开腹胆总管切开取石、T管引流, 转变为腹腔镜下胆总管切开取石一期缝合或腹腔镜下胆总管切开取石、T管引流, 腹腔镜下经胆囊管胆道镜取石,或胆囊切除, 术前或术后应用十二指肠镜取出胆总管结石. 腹腔镜、十二指肠镜、胆道镜的三镜联合应用将会是今后治疗胆囊结石合并胆总管结石的现代外科治疗模式.     

乳头括约肌切开对取石术后胆总管直径及结石复发的影响

乳头括约肌切开对取石术后胆总管直径及结石复发的影响董米连刘伟林林祖朝胆囊切除加胆总管切开取石Ｔ管引流术（简称胆道取石）术后胆总管直径对胆管结石复发有何影响，经内镜乳头括约肌切开（ｅｎｄｏｓｃｏｐｉｃｓｐｈｉｃｔｅｒｏｔｏｍｙ，ＥＳＴ）对胆道取石术后胆...     

腹腔镜胆囊切除术与小切口胆总管探查术的联合应用

目的探讨腹腔镜胆囊切除联合小切口胆总管探查治疗胆囊结石合并胆总管多发结石。方法本组23例胆囊结石合并胆总管多发结石,均来自2007年12月至2012年7月我院收治患者,采用腹腔镜下切除胆囊并解剖显露胆总管前壁,镜下确定腹壁切口位置,做3～5 cm切口入腹,经小切口切开胆总管,取石钳取石后根据情况用纤维胆道镜/硬性输尿管镜行胆道探查取石。结果本组无1例中转扩大切口手术,手术时间90～160 min,平均（120±10）min;住院时间10～20 d,平均13 d;21例拔除＂T＂管痊愈出院;2例术后＂T＂管造影B超检查右肝管残留结石,带管出院,术后6周经胆道镜取石痊愈;2例肺部感染,伤口均甲级愈合。结论该术式治疗胆囊结石合并胆总管多发结石创伤小,较单纯小切口安全,比全腹腔镜术式节省时间,取石彻底,适合基层医院。     

Cystic duct directly joining the main pancreatic duct

A unique anomaly of the direct union between the cystic duct and the main pancreatic duct is presented. A 19-year-old man with a history of repeated epigastralgia underwent endoscopic retrograde cholangiopancreaticography that showed a direct union between the cystic duct and the main pancreatic duct. No pancreaticobiliary maljunction was noticed. Cholecystectomy accompanied by resection of the long cystic duct was performed. The excised gallbladder showed cholesterolosis, chronic cholecystitis, and hyperplasia of the pseudopyloric glands microscopically. The patient has been well for 3 years since surgery.     

胆囊管癌伴右副肝管直接汇入胆囊管1例报告

正胆道变异的类型繁多,包括胆囊管与肝总管并行低位汇合,胆囊管汇入右肝管、副肝管等~([1])。其中副肝管又叫Luschka胆管或迷走胆管,是胚胎期肝十二指肠发育不全的常见畸形,直接连接胆囊和肝内胆管通道,常开口于胆总管,其次是右肝管和胆囊管~([2])。本文报道1例较大右副肝管直接汇入胆囊管,并伴有胆囊管癌的罕见病例。1病例资料患者男性,63岁,因"间断性上腹部胀痛不适2年,加重伴     

Anomalous pancreaticobiliary duct union associated with bile duct carcinoma

An abnormal high union of the common bile duct and the main pancreatic duct, without accompanying cystic dilatation of the bile ducts, is a rare occurrence. A case of obstructive jaundice due to bile duct carcinoma in connection with this anomaly is reported.     

Adaptative bile duct proliferative response in experimental bile duct ischemia

BACKGROUND/AIMS: A rat model of bile duct ischemia was established and used to examine the potential of bile duct proliferation to provide an adaptative response in cholestatic disorders. METHODS: Rats underwent partial or complete arterial deprivation of the liver. Serum biochemical tests, histological analyses and bile secretion measurements were performed at different time points up to 6 weeks after surgery. RESULTS: Rats developed biochemical signs of cholestasis exclusively after complete arterial deprivation. Within 4h, cholangiocytes in these rats showed morphological signs of cell damage. After 48h, they displayed VEGF expression and became proliferative. The proportion of Ki67-labeled cholangiocytes ( approximately 30%) was similar in interlobular bile ducts and periportal ductules. A ductular reaction made of well-formed bile ducts confined to portal tracts developed within 1 week. Bile flow which was initially decreased, was restored at 3 weeks, while the biochemical signs of cholestasis completely resolved at 6 weeks. At this time, the number of bile duct sections was maximal. Fibrosis intensity was also maximal, although moderate (相似文献   

肝内外胆管结石的内镜治疗

胆道疾病内镜治疗最常见的途径有经口(peroral)、经皮(percutaneous)和腹腔镜(Lc)治疗三种,根据适应征选择不同的治疗方法.本文综述肝内外胆管结石经口十二指肠镜及经皮胆管镜治疗的进展,具体操作方法,适应症的选择,合并症的产生、预防和治疗.     

New cannulation method for pancreatic duct cannulation-bile duct guidewire-indwelling method

The patient was a 58-year-old male with symptomatic alcoholic chronic pancreatitis.Since a 10 mm calculus was observed in the pancreatic body and abdominal pain occurred due to congestion of pancreatic juice,endoscopic retrograde cholangiopancreatography was conducted for assessment of the pancreatic duct and treatment of pancreatic calculus.Pancreatogram was slightly and insuff iciently obtained by injecting the contrast media via the common channel of the duodenal main papilla.We tried to cannulate selectively into the pancreatic duct for a clear image.However,the selective cannulation of the pancreatic duct was difficult because of instability of the papilla.On the other hand,selective cannulation of the bile duct was relatively easily achieved.Therefore,after the imaging of the bile duct,a guidewire was retained in the bile duct to immobilize the duodenal papilla and cannulation of the pancreatic duct was attempted.As a result,selective pancreatic duct cannulation became possible.It is considered that the bile duct guidewire-indwelling method may serve as one of the useful techniques for cases whose selective pancreatic duct cannulation is diff icult("selective pancreatic duct diff icult cannulation case").     

A case of cholecystohepatic duct with atrophic common hepatic duct

BackgroundCholecystohepatic ducts are rare congenital variants of the biliary tree.Case outlineAn 81-year-old woman presented with biliary colic and elevated liver function tests. An ERCP demonstrated a common bile duct stone and stricture of the common hepatic duct. An operative cholangiogram demonstrated an atrophic common hepatic duct and retrograde filling of the gallbladder through a large cholecystoheptic duct. The patient had a cholecystectomy and reconstructive cholecystohepatic duct jejunostomy.DiscussionThis case demonstrates a rare congenital anomaly where the gallbladder fills retrograde during an intraoperative cholangiogram despite clipping of the cystic duct. The major path of biliary drainage was through a large cholecystoheptic duct similar to a gallbladder interposition; however, the common hepatic duct was still present but atrophic. This anomaly has not been described previously.