腹腔镜下胆总管探查术中逐级导管扩张与球囊导管扩张治疗胆总管下段狭窄的对比研究

目的 分析比较腹腔镜下胆总管探查术中逐级导管扩张与球囊导管扩张治疗胆总管下段狭窄的安全性及有效性。方法 回顾性分析成都市第二人民医院2017年4月至2019年4月收治的胆总管结石合并胆总管下段狭窄患者56例，其中行逐级导管扩张术30例，行球囊导管扩张术26例。对比分析腹腔镜下胆总管探查中行逐级导管扩张术（以下简称逐级导管组）及球囊导管扩张术（以下简称球囊导管组）的临床治疗效果。结果 56例手术均成功，围手术期均无死亡或其他严重并发症发生。两组术后氨基转移酶（AST和ALT）、直接胆红素（DBIL）、手术时间、术中出血量、术后并发症等情况差异无统计学意义（P＞0.05）；两组在鼻胆管拔除时间、术后住院时间、术后血淀粉酶值、术后胃肠功能恢复时间方面存在差异，有统计学意义（P＜0.05）。结论 腹腔镜下胆总管探查术中逐级导管扩张或球囊导管扩张均可保护十二指肠乳头及Oddi括约肌的正常生理功能，安全有效地解除胆总管下段狭窄，术后并发症少、恢复快。

A comparative study on the treatment of lower choledochal stenosis with gradual catheter dilation and balloon catheter dilation in laparoscopic exploration of common bile duct

Objective To analyze and compare the safety and effectiveness of gradual catheter dilation and balloon catheter dilation in laparoscopic exploration of the common bile duct for treatment of lower choledochal stenosis. Methods The data of 56 patients with choledocholithiasis and lower choledochal stenosis were analyzed retrospectively. Among them, 30 cases received gradual catheter dilation and 26 cases received balloon catheter dilation. The clinical effect of the two methods were compared and analyzed. Results All 56 cases were operated successfully. No death or other serious complications occurred in the perioperative period. There was no statistical significant difference between the two groups in postoperative aminotransferase (AST and ALT), postoperative direct bilirubin (DBIL), operation time, intraoperative blood loss, postoperative complication incidence (P>0.05). There were statistical significant differences between the two groups in the time of extraction of nasobiliary duct, postoperative hospitalization time, postoperative level of blood amylase and the time of gastrointestinal function recovery (P<0.05). Conclusion Both gradual catheter dilation and balloon catheter dilation during laparoscopic exploration of common bile duct can protect the normal physiological function of duodenal papilla and Oddi’s sphincter, safely and effectively relieves the lower choledochal stenosis with fewpostoperative complications and fast recovery.