腹腔镜手术治疗胆囊结石合并胆总管结石的临床疗效

目的:比较腹腔镜手术与传统开腹手术治疗胆囊结石合并胆总管结石的临床效果.方法:按照收治随机数字表法将河北联合大学附属医院收治80例胆囊结石合并胆总管结石患者均分为观察组与对照组,分别给予腹腔镜手术和传统开腹手术治疗,比较两组患者手术一般情况、术后并发症发生情况以及随访期间残石率、胆漏率、复发率.结果:观察组患者手术时间、术中出血量、肛门排气时间、下床活动时间及出院时间均显著少于对照组(60.28 min±11.64 min vs 105.61 min±21.16 min、38.36 m L±8.31m L vs 148.36 m L±16.20 m L、1.76 d±0.82d vs 3.10 d±1.12 d、1.53 d±0.78 d vs 2.52d±1.05 d、6.62 d±2.13 d vs 14.27 d±4.58d),差异具有统计学意义(P0.05);观察组并发症总发生率显著低于对照组(7.50%vs27.50%),差异具有统计学意义(P0.05);观察组患者残石率、胆漏率及复发率均显著低于对照组(5.00%vs 20.00%、2.50%vs15.00%、0.00%vs 10.00%),差异具有统计学意义(P0.05).结论:采用腹腔镜手术治疗胆囊结石合并胆总管结石,创伤小,术后恢复快,能有效降低并发症发生率、残石和胆漏率,并减少术后复发,安全可靠,值得推广.     

两种不同术式治疗胆囊结石合并胆总管结石临床疗效对比分析

目的对比传统开腹胆总管切开取石+胆囊切除术与经十二指肠镜逆行胰胆管造影(endoscopic retrograde cholangio-pancreatography,ERCP)+内镜乳头括约肌切开取石术(endoscopic sphincterotomy,EST)+腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗胆囊结石合并胆总管结石临床疗效。方法回顾性分析2016-09～2017-09在该院接受治疗的88例胆囊结石合并胆总管结石患者的基本资料。将上述患者分为开腹组(开腹胆总管切开取石+胆囊切除术,44例)和ERCP+EST+LC组(44例)。比较两组患者的一般临床资料、手术时间、住院时间、住院费用、术前术后肝功能及术后并发症情况。结果两组术前谷丙转氨酶(ALT)、谷草转氨酶(AST)方面比较差异无统计学意义(P 0. 05),而在手术时间、住院时间、住院费用、术后ALT、术后AST、术后总并发症发生率方面比较差异有统计学意义(P 0. 05)。结论 ERCP+EST+LC组治疗胆囊结石合并胆总管结石总体优于传统开腹胆总管切开取石+胆囊切除术,且手术时间及住院时间短,住院费用少,术后肝功能损伤小,安全性较高,值得推广。     

内镜腹腔镜联合治疗胆囊结石并胆总管结石

胆囊结石并继发或原发胆总管结石的传统治疗方法是开腹切除胆囊、胆总管切开取石及T管引流。近年来,随着内镜和腹腔镜技术的日益进步和完善,内镜下十二指肠乳头括约肌切开术(EST)和腹腔镜胆囊切除术(LC)正逐步替代开腹手术。我科自1999年10月到2001年3月共治疗该类疾病30例,效果良好,现报告如下。 1.一般资料:本组30例患者,男11例,女19例,年龄28～75岁,平均51.5岁。均经2次以上B超诊断为胆囊结石     

两种微创术式治疗胆囊结石合并胆总管结石的效果比较

目的比较腹腔镜下胆囊切除术(LC)联合内窥镜逆行胰胆管造影术(ERCP)与LC联合腹腔镜下胆总管切开取石术(LCBDE)治疗胆囊结石合并胆总管结石的效果。方法回顾性收集2019年1月至2021年12月广西医科大学附属武鸣医院收治的64例胆囊结石合并胆总管结石患者,其中按计划筛选出接受LC+LCBDE(LCBDE组)患者32例,接受LC+ERCP(ERCP组)患者32例。比较两组患者相关临床指标。结果ERCP组的手术时间(3.0±1.0)d,短于LCBDE组的(4.7±1.4)d;术后住院时间(5.3±2.0)d,短于LCBDE组的(13.1±4.7)d;住院费用低于LCBDE组,差异均有统计学意义(均P<0.05)。结论LC+LCBDE和LC+ERCP均为治疗胆囊结石合并胆总管结石有效且安全的治疗方式,但LC+ERCP更能缩短手术时间和住院时间,减少住院费用,在适应证下,可作为首选治疗方式。     

内镜与腹腔镜联合治疗胆囊结石合并胆总管结石的疗效

目的探讨内镜与腹腔镜联合治疗老年急腹症中胆囊结石合并胆总管结石的临床应用价值。方法按照随机数字表法将112例胆囊结石合并胆总管结石患者分为对照组与观察组,其中观察组行内镜及腹腔镜治疗,对照组行开腹手术治疗,记录并比较两组患者手术时间、术中出血量、术后恢复情况及住院时间。结果观察组的平均手术时间与对照组比较无明显差异(t=0.65,P>0.05);但是观察组的平均术中出血量较对照组明显降低,且差别有统计学意义(t=14.21,P<0.05)。观察组患者术后切口感染发生率、术后镇痛药物使用率、肛门排气时间及肠鸣音恢复时间均明显低于对照组,且差别有统计学意义(t或χ2=5.11、9.28、7.48、7.89,均P<0.05)。观察组患者平均住院时间为(8.13±1.52)d,对照组患者平均住院时间为(15.33±1.37)d,两组比较差别有统计学意义(t=7.21,P<0.05)。结论内镜联合腹腔镜治疗胆囊结石合并胆总管结石具有创伤小、出血少、术后伤口疼痛轻、恢复快等优点,明显优于开腹手术,具有较高的优越性和临床使用价值,值得临床推广应用。     

两种手术方案治疗胆囊结石合并胆总管结石患者效果比较研究

目的 比较开腹手术与腔镜联合手术方案治疗胆囊结石合并胆总管结石患者的疗效。 方法 2015年6月~2017年6月我科收治的胆囊结石合并胆总管结石患者120例,采用随机数字表法将其分为开腹手术治疗60例和腔镜联合胆道镜探查手术治疗60例。 结果 60例开腹组患者均一次性清除结石,而腔镜组1例患者因胆总管结石嵌顿,无法取出,采取体外冲击波碎石后,再行胆道镜取石成功;腔镜组患者手术时间、术中失血量、术后胃肠功能恢复时间和住院时间分别为（110.57±10.87） min、（32.90±3.79） ml、（1.47±0.53） d和（6.72±1.74） d,均显著优于开腹组的（132.73±25.20） min、（84.33±8.31） ml、（3.51±1.05）d和（13.67±3.80） d（P<0.05）;腔镜组患者术后并发症发生率为3.3%,显著低于开腹组的20.0%（P<0.05）。 结论 两种手术方案用于治疗胆囊结石合并胆总管结石患者在结石清除效果方面较为接近,但腔镜联合手术方案的应用可有效减少手术创伤,加快术后康复进程。     

胆囊结石合并胆总管结石两种微创治疗方式效果比较

目的对比腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)+腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)与内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)+内镜十二指肠乳头括约肌切开术(endoscopic sphincterotomy,EST)+LC治疗胆囊结石合并胆总管结石的临床效果。方法将100例胆囊结石合并胆总管结石患者随机分为观察组(n=52)和对照组(n=48)。观察组行LC+LCBDE;对照组行ERCP+EST,1～3 d后再行ERCP+EST+LC。比较两组患者的临床指标。结果观察组住院费用、手术时间、住院天数比对照组减少,差异有统计学意义(P 0.05)。两组患者胆结石清除成功率、并发症发生率、复发率比较,差异无统计学意义(P0.05)。结论 LC+LCBDE与ERCP+EST+LC治疗胆囊结石合并胆总管结石同样安全有效,但是LC+LCBDE住院时间较短,住院费用较少,可作为EST失败后的有效补救手术方式。     

腹腔镜胆囊切除术联合胆总管探查术治疗胆囊结石合并胆总管结石临床观察

目的分析腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)联合胆总管探查术(laparoscopic common bile duct exploration,LCBDE)治疗胆囊结石合并胆总管结石的临床效果。方法选取2015-07~2016-03该院收治的胆囊结石合并胆总管结石患者90例,按手术方法不同分为对照组和观察组,各45例。对照组采用经内镜十二指肠乳头括约肌切开术(endoscopic sphincterotomy,EST)治疗,观察组采用LC+LCBDE治疗,对比两组患者手术情况及并发症发生率。结果两组患者住院时间、住院费用、手术成功率及残余结石率比较差异无统计学意义(P0.05);观察组一期治愈率明显高于对照组,手术时间短于对照组,差异有统计学意义(P0.05);观察组并发症发生率为11.11%,明显低于对照组的31.11%,差异有统计学意义(P0.05)。结论 LC+LCBDE治疗胆囊结石合并胆总管结石临床效果显著,取石率高,可有效缓解患者临床症状,降低二次手术的风险,并发症少,安全性高,值得在临床应用中推广。     

腹腔镜、胆道镜联合治疗胆囊结石合并胆总管结石疗效观察

目的观察腹腔镜、胆道镜联合治疗胆囊结石合并胆总管结石的临床效果。方法胆囊结石合并胆总管结石患者115例,随机分为A组56例、B组59例。其中A组给予腹腔镜、胆道镜联合手术治疗,B组给予传统开腹手术治疗。比较两组手术时间、术中出血量、术后通气时间、住院时间及术后并发症。结果 A组住院时间、术中出血量、术后通气时间均少于B组,手术时间长于B组,P均<0.01。A组术后切口感染0例、胆瘘1例、结石残留1例,并发症发生率3.57%;B组分别为7、4、3例和23.72%;两组并发症发生率比较,P<0.01。结论腹腔镜、胆道镜联合治疗胆囊结石合并胆总管结石疗效确切,且创伤小、住院时间短、术后恢复好、并发症少。     

Technical aspects in the laparoscopic management of complicated common bile duct stones

The management of common bile duct (CBD) stones traditionally required open laparotomy and bile duct exploration. With the advent of endoscopic and laparoscopic technology in the latter half of last century, endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC) has become the mainstream treatment for CBD stones and gallstones in most medical centers around the world. However, in certain situations, ERCP cannot be feasible because of difficult cannulation and extraction. ERCP can also be associated with potential serious complications, in particular for complicated stones requiring repeated sessions and additional maneuvers. Since our first laparoscopic exploration of the CBD (LECBD) in 1995, we now adopt the routine practice of the laparoscopic approach in dealing with endoscopically irretrievable CBD stones. The aim of this article is to describe the technical details of this approach and to review the results from our series.     

Current management of the gallbladder after endoscopic sphincterotomy for common bile duct stones

Background: Traditionally, a cholecystectomy is performed after successful endoscopic sphincterotomy and removal of common bile duct (CBD) stones, except in patients of advanced age or with substantial comorbidity. In practice, however, the gallbladder is left in situ more frequently now in patients without contraindications for surgery. The criteria by which patients are selected for an elective cholecystectomy are unclear. The aim of the present study was to establish the proportion of patients for whom a “wait-and-see” strategy was advised and to determine which, if any, patient characteristics had influenced this decision. Methods: This study included 71 patients, all younger than 80 years of age, with both CBD stones and a gallbladder containing stones in whom endoscopic clearance of bile duct stones was achieved. Results: Three patients underwent a cholecystectomy within 1 week because of acute cholecystitis. Among the remaining 68 patients, cholecystectomy was recommended for 42 patients and a wait-and-see strategy was advised for 26 patients. Patient characteristics were identical in both groups except for the American Society of Anesthesiologists Physical Status (ASA) score. The ASA score was higher in the wait-and-see group, but 69% of the patients in this group had an ASA score of I or II. Six patients in the wait-and-see group had symptoms; five patients underwent cholecystectomy. The outcome of surgery was no worse in this group than in the cholecystectomy group. Conclusions: Selection of patients for either elective cholecystectomy or wait-and-see was not based on established criteria but mainly dependent on preference of the specialist. The outcome of surgery, indicated in 23% of the patients in the wait-and-see group was comparable with elective cholecystectomy. A controlled trial comparing both treatment options in patients younger than 80 years of age should be performed. (Gastrointest Endosc 1997;46:514-9.)     

Outcome of gallbladder preservation in surgical management of primary bile duct stones

AIM: To evaluate the methods and outcome of gallbladder preservation in surgical treatment of primary bile duct stones. METHODS: Thirty-five patients with primary bile duct stones and intact gallbladders received stone extraction by two operative approaches, 23 done through the intrahepatic duct stump (RBD-IDS, the RBD-IDS group) after partial hepatectomy and 12 through the hepatic parenchyma by retrograde puncture (RBD-RP, the RBD-RP group). The gallbladders were preserved and the common bile duct (CBD) incisions were primarily closed. The patients were examined postoperatively by direct cholangiography and followed up by ultrasonography once every six months. RESULTS: In the RBD-IDS group, residual bile duct stones were found in three patients, which were cleared by a combination of fibrocholedochoscopic extraction and lithotripsy through the drainage tracts. The tubes were removed on postoperative day 22 (range: 16-42 days). In the RBD-RP group, one patient developed hemobilia and was cured by conservative therapy. The tubes were removed on postoperative day 8 (range: 7-11 days). Postoperative cholangiography showed that all the gallbladders were well opacified, contractile and smooth. During 54 (range: 6-120 months) months of follow-up, six patients had mildly thickened cholecystic walls without related symptoms and further changes, two underwent laparotomies because of adhesive intestinal obstruction and gastric cancer respectively, three died of cardiopulmonary diseases. No stones were found in all the preserved gallbladders. CONCLUSION: The intact gallbladders preserved after surgical extraction of primary bile duct stones will not develop gallstones. Retrograde biliary drainage is an optimal approach for gallbladder preservation.     

三镜联合分期手术与腹腔镜手术治疗老年胆总管结石合并胆囊结石患者疗效对比研究

目的 探讨采用三镜联合分期手术与全腹腔镜同期手术治疗老年结石性胆道梗阻并发不同程度急性胆管炎患者的效果。方法 回顾性分析青岛市第三人民医院收治的老年胆总管结石伴急性胆管炎合并胆囊结石患者75例,其中35例观察组患者在入院后急诊行ERCP术,取出胆总管结石或留置胆管支架引流,择期再次入院行腹腔镜胆囊切除术(LC)或LC联合腹腔镜下胆总管取石术(LCBDE),40例对照组患者入院后急诊行LC联合LCBDE术。结果 观察组两次手术时间显著长于对照组(P<0.05),但术中出血量显著少于对照组(P<0.05);手术后观察组WBC计数、NEUT百分比、血清CRP和PCT水平均显著低于对照组(P<0.05);术后,观察组血清脑钠肽(BNP)和CK水平分别为(427.0±327.0)pg/ml和(95.0±30.0)U/L,显著低于对照组【分别为(944.0±648.0)pg/ml和(149.0±67.0)U/L,P<0.05】,而血清肌钙蛋白(TNT)和乳酸脱氢酶(LDH)水平分别为(62.8±54.5)pg/ml和(272.0±48.0)U/L,显著高于对照组【分别为(3...     

内镜与手术治疗胆总管结石的疗效比较

目的: 分析内镜和手术治疗胆总管结石的效果.方法: 回顾分析我院2005.01/2007-12胆总管结石500例,其中内镜治疗302例,外科手术198例.采用内镜下括约肌切开取石术(endoscopic sphincterotomy,EST)、EST后内镜下放置内外胆管引流管(ENBD)等联合腹腔镜胆囊切除术,比较内镜治疗和常规手术治疗的效果.以及并发症发生率等方面的不同.结果: 胆总管结石内镜取石成功率86.09%.EST后并发症发生率为9.27%,胆总管结石外科手术治疗早期并发症发生率为10.1%,后期为6.1%,两组各种并发症有显著差异(P<0.05).内镜取石平均住院时间仅为4 d:外科手术住院时间平均14d.结论: EST对胆总管结石在住院时间和并发症发生率方面都明显优于常规手术.     

Association between common bile duct stones and treated hypothyroidism

BACKGROUND/AIMS: The purpose of this study was to investigate the frequency of diagnosed hypothyroidism in patients with common bile duct stones. METHODOLOGY: The common bile duct stone group (Group I) consisted of all the patients who had verified gallstones in the common bile duct in endoscopic retrograde cholangiopancreatography during 1995. The control group (Group II) was matched for age, sex, and hospital admission. These patients did not have diagnosed gallbladder or common duct stones. In both groups there were 86 patients (56 women and 30 men). The median age in these groups was 73 (range: 22-92) years at the time of common bile duct stone diagnosis. Medical records of all patients were reviewed. RESULTS: In Group I the prevalence of previously diagnosed hypothyroidism was 7/86 (8%) compared with 1/86 (1%) in Group II (P = 0.01). Hypothyroidism was previously diagnosed only in the common bile duct stone patients (Group I) of over 60 years of age, where the prevalence was 7/66 (11%). In addition, we studied 36 consecutive gallbladder stone patients (Group III) of over 60 years, who had no evidence of common bile duct stones. Hypothyroidism had been diagnosed in them less frequently (2/36 = 6%) than in the age and hospital admission matched common bile duct stone patients (P = 0.01). Other diagnosed endocrine disorders did not differ between the study groups. CONCLUSIONS: There is a significant association between the common bile duct stones and previously diagnosed hypothyroidism. There stronger association between the common bile duct stones and hypothyroidism compared to gallbladder stones and hypothyroidism suggests a mechanism other than merely the cholesterol metabolism mediated mechanism. The 11% prevalence of previously diagnosed hypothyroidism in the common bile duct stone patients of over 60 years of age suggests all patients with common bile duct stones be screened for current thyroid dysfunction.     

一步法和分步法治疗胆囊结石合并胆总管结石患者疗效及并发症分析

目的 探讨一步法与分步法手术治疗胆囊结石合并胆总管结石患者的疗效.方法 2016年1月～2019年6月我院诊治的胆囊结石合并胆总管结石患者152例,其中87例接受一步法手术,即行腹腔镜胆囊切除(LC)和胆总管探查取石(LCBDE)术,65例接受分步法手术,即行内镜逆行胰胆管造影/乳头括约肌切开(ERCP/EST)和LC...