腹腔镜下经腹顺行引导法内镜乳头切开术905例

目的探讨腹腔镜下经腹顺行引导法内镜乳头切开术(LEST)的手术方法和适应证。方法回顾性分析2003年3月至2015年8月期间施行LEST治疗905例患者的临床资料;分为胆总管末端狭窄组和细径胆总管结石组。采用SPSS19.0软件进行统计分析,组间计量资料用均数±标准差(x珋±s)表示,采用t检验;术后并发症发生率采用χ2检验,P0.05为差异有统计学意义。结果胆总管末端狭窄组:行LEST 508例,364例(71.6%)乳头狭窄切开成功后行直接一期缝合术,9例(1.8%)留置输尿管导管后行一期缝合术,125例(24.6%)留置鼻胆管后行一期缝合术,10例中转为T管引流术。术后发生轻症胰腺炎9例(1.8%),胆漏23例(4.5%),残石2例(0.4%)。细径胆总管结石组:行LEST 397例,370例(93.2%)乳头切开后取石成功,18例乳头切开后排石成功,9例乳头切开失败而中转为其他术式。术后胆漏5例(1.3%),轻症胰腺炎14例(3.5%),残石3例(0.7%)。两组患者术后总并发症发生率及术后胰腺炎、术后残余结石等并发症发生率差异无统计学意义(P0.05);胆总管末端狭窄组(4.5%)术后胆漏发生率高于细径胆总管结石组(1.2%);胆总管末端狭窄组(98.0%)手术成功率高于细径胆总管结石组(93.2%),差异均有统计学意义(χ2=7.939、13.272,P0.05)。结论只要病例选择合适,腹腔镜下经腹顺行引导法内镜乳头切开术是可行、有效和安全的。

Transabdominal consequent guidance technology of duodenoscopic sphincteropapillotomy during the course of laparoscopy：report of 905 cases

Objective To explore the operative procedures and indications of transabdominal consequent guided endoscopic papilla incision ( LEST ) in the process of laparoscopy . Methods The clinical data of 905 patients from March 2003 to August 2015 , who underwent LEST were analyzed retrospectively .Patients were divided into the common bile duct stenosis group and the small diameter of the common bile duct stones .Statistical analysis were performed by using SPSS 17.0 software.Measurement data were expressed as Mean ± SD, and were examined by t test.Count data, such as postoperative complication rate was examined by χ2 test.A P value <0.05 was considered as significant difference . Results In the stenosis group: LEST was performed on the 508 cases, while 364 cases ( 71.6%) of primary suture after successful papillary stenosis cutting , 9 cases (1.8%) of primary suture after indwelling ureteral catheter , 125 cases (24.6%) of underwent primary suture after detaining nasobiliary drainage;10 cases of conversion to T tube drainage .The occurrence of mild pancreatitis after operation in 9 cases (1.8%).Bile leakage occurred in 23 cases (4.5%).Two cases (0.4%) of residual stones occurred after primary suture.In small diameter group:LEST was performed on 397 cases, including 370 cases (93.2%) of successful removement of common bile duct stones by duodenoscopic papillotomy and endoscopic stone net, 18 cases of the stone expulsion after duodenoscopic papillotomy and nine cases were converted to other operations.Bile leakage occurred in 5 cases (1.3%).The occurrence of mild pancreatitis after operation in 14 cases (3.5%).Three cases (0.7%) of residual stones occurred after primary suture.There were no statistical significant difference between two groups of patients in terms of postoperative pancreatitis and residual stones (P>0.05).However, postoperative bile leakage incidence of 4.5% in common bile duct stenosis group was higher than 1.2%of the small diameter of common bile duct stones group .The surgical success rate of 98.0%in end of the common bile duct stenosis group was higher than 93.2%in the small diameter of common bile duct stones group, with significant differences (chi square=7.939, 13.272, P<0.05). Conclusion If patients are suitable, the transabdominal consequent guidance technology of LEST is safe and effective .