腹腔镜胆管探查术并发症

目前，腹腔镜下胆管探查术已经部分取代开腹手术，成为治疗胆总管结石的常用术式：但由于术中三维立体感觉变成二维视觉平面，丧失了手指触摸等优势，其术后并发症较开腹手术高。     

经内镜鼻胆管引流术治疗胆道术后胆漏

胆漏是胆道手术常见的严重并发症。我们自2002～2006年经内镜鼻胆管引流术（endoscopic nasobiliary drainage,ENBD）治疗胆道术后胆漏8例,取得了较满意的效果,现报告如下。     

经内镜鼻胆管引流术的护理体会

各种良、恶性病变引起的胆道梗阻是肝胆外科临床常见的病症，梗阻性黄疸病人过去常采用经皮肝穿刺胆道引流术（PTCD）达到减轻黄疸的目的，随着纤维内镜技术的发展，新的胆道引流方式：经内镜鼻胆管引流术(ENBD)在临床处理各种原因所致的胆道梗阻方面起着越来越大的作用。我院自2001-0l／2003-0l行ENBD共30例，均取得满意疗效。     

经内镜鼻胆管引流术治疗胆管梗阻

经内镜鼻胆管引流术治疗胆管梗阻李健屠恒来戴云龙朱洪连１９９４年８月至１９９６年１２月，我们行经内镜鼻胆管引流术（ＥＮＢＤ）治疗胆道梗阻，疗效满意，兹作报道。一、材料和方法本组５８例，男３２例，女２６例，年龄２５～７３岁，平均４８岁。术前经Ｂ超、ＣＴ诊...     

经内镜逆行胰胆管取石术后留置鼻胆管对于预防并发症的作用

目的明确经内镜逆行胰胆管造影术（ERCP）取石术后留置鼻胆管能否降低术后并发症发生率。方法回顾性分析697例因胆总管结石行ERCP治疗的患者资料,根据是否行鼻胆管引流分为鼻胆管组（538例）及对照组（159例）,总结术后两组患者胰腺炎、胆管炎及出血的发生率。结果鼻胆管组与对照组之间,术后胰腺炎（4．3％比6．3％,P〉0．05）及出血（1．3％比1．9％,P〉0．05）发生率无统计学差异,术后胆管炎发生率明显降低（1．3％比3．8％,P〈0．05）。结论ERCP取石术后留置鼻胆管可以降低胆管炎的发生率。     

鼻胆管引流术在胆总管结石内镜下十二指肠乳头切开取石后的运用

[目的]探讨鼻胆管引流术(ENBD)在胆总管结石内镜下十二指肠乳头切开(EST)取石后的作用。[方法]对160例胆总管结石EST切开取石的内镜下逆行胰胆管造影(ERCP)患者进行临床分析,其中80例为EST取石术后未放置鼻胆管作为对照组,另80例放置鼻胆管为治疗组,观察2组病例EST取石后并发症情况。[结果]治疗组并发症2例(1例术后出血、1例鼻胆管脱落),发生率2.5%(2/80),26例伴有黄疸,术后2~4 d消退;对照组并发症12例(8例胰腺炎、2例术后出血、1例胆道感染、1例黄疸加重),发生率15.0%(12/80),23例伴有黄疸,术后3~7 d消退。[结论]胆总管结石EST取石后采用ENBD能有效预防并发症的发生,黄疸消退时间缩短。     

腹腔镜手术在胆管结石诊治中的应用

目的进一步调高胆管结石的手术治疗效果。方法对278例胆管结石患者行腹腔镜手术。结果278例手术全部成功,术后发生胆漏8例,延迟出血1例,残余结石4例;未出现其他并发症。结论腹腔镜治疗胆管结石效果理想、创伤小、并发症发生率低;充分术前评估、掌握手术指征及手术技巧有助于提高诊治水平。     

经内镜胆管引流术治疗急性胰腺炎

为达到最佳治疗效果，而又减少损伤，７６例急性胰腺炎（ＡＰ）其中３例为重症急性胰腺炎（ＳＡＰ）患者接受了经内镜胆管引流术（ＥＢＤ），引流成功６９例。ＡＰ顺利治愈６７例，治愈率９７．１％，平均治愈时间８．５天。而ＥＢＤ术不成功改为其它治疗的７例，平均治愈时间长达１４．５天。结果表明ＥＢＤ具有简便、安全、疗效好、对患者打击小的优点     

经内镜鼻胆管引流术治疗胆胰疾病64例的体会

自 1997年 7月至 2 0 0 1年 9月 ,本院共开展经内镜逆行胰胆管造影检查 (ＥＲＣＰ) 5 4 8例 ,其中因治疗急性化脓性胆管炎及非胆源性胰腺炎、预防胆道感染或防止结石嵌顿、治疗胆瘘及减黄治疗而行鼻胆管引流术 (ＥＮＢＤ) 6 4例 ,取得满意疗效。现报告如下。1　临床资料本组患者男 2 7例 ,女 37例 ,平均年龄 5 3 2 (34～78)岁。急性化脓性胆管炎 32例 ,梗阻性黄疸减黄引流 19例 ,ＥＳＴ后引流 9例 ,非胆源性胰腺炎 2例 ,胆道术后胆瘘 2例。引流管留置时间 2～ 36ｄ ,平均 4 7ｄ。2　器材与方法2 .1　器材　ＯｌｙｍｐｕｓＪＦ ＩＴ30型纤…     

经内镜鼻胆管引流术治疗急性化脓性胆管炎25例临床观察

目的观察经内镜鼻胆管引流术（ENBD）治疗急性化脓性胆管炎（acute suppurative cholangitis,ASC）的临床疗效。方法对25例临床诊断ASC患者应用ENBD同时施行十二指肠乳头括约肌切开术（EST）,观察总结临床疗效。结果 25例患者病情在插管胆道减压引流后都得到迅速缓解。结论经内镜ENBD治疗ASC疗效确切、安全性高,绝大多数情况下可替代开腹胆道减压引流术,可作为治疗的首选方法。     

The case for laparoscopic common bile duct exploration

The modern surgeon's approach to choledocholithiasis depends his or her view of cholangiography. During the early 1990 there was a swing away from cholangiography, which had previously been common practice. This was because of perceptions of difficulty with the technique, the time it took, and perhaps an implied increase in costs because of the time factor. There was no evidence on which to base this decision. This led to a marked upswing in the use of endoscopic retrograde cholangiopancreatography (ERCP). There were a large number of ERCPs with normal results performed prior to laparoscopic cholecystectomy. This paper states the case for intraoperative cholangiography and common bile duct clearance at the time of cholecystectomy. It is hoped that this technique will be adopted so patients can undergo a single procedure to remove their gallstones and common bile duct stones if they exist and to decrease the incidence of normal preoperative ERCPs and the need for a second procedure postoperatively to clear stones if they are found.     

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...     

LCBDE术一期缝合治疗胆总管结石患者效果研究

目的 探讨采用腹腔镜胆总管探查术(LCBDE)一期缝合治疗胆总管结石患者的临床疗效。方法 2018年1月～2021年10月我院收治的74例胆总管结石患者,其中31例对照组患者接受LCBDE术联合T管引流治疗,另43例观察组患者接受LCBDE术胆总管一期缝合治疗。术后随访所有患者6个月。使用全自动生化分析仪检测血生化指标,采用放射免疫法检测应激反应指标肾上腺素(A)、促肾上腺皮质激素(ACTH)和皮质醇(COR)。结果 观察组手术时间、腹腔引流时间和住院日分别为(91.3±12.6)min、(3.3±1.2)d和(5.9±1.2)d,显著短于对照组【分别为(115.4±19.2)min、(4.5±1.4)d和(8.6±1.5)d,P<0.05】;手术前后,两组血清肝功能指标变化均无显著性差异(P>0.05);在术后3 d,观察组血清A、ACTH和COR水平分别为(1.2±0.3)nmol/L、(13.6±4.1)ng/mL和(212.9±21.4)ng/mL,显著低于对照组【分别为(1.6±0.4)nmol/L、(17.2±4.8)ng/mL和(256.4±35.7)ng/m...     

腹腔镜胆总管探查术联合腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石患者临床疗效研究

目的 探讨采用腹腔镜胆总管探查术(LCBDE)联合腹腔镜胆囊切除术(LC)治疗胆囊结石合并胆总管结石患者的临床疗效.方法 2016年5月 ～2020年7月我院诊治的85例胆囊结石合并胆总管结石患者,其中41例接受LCBDE联合LC术,另44例接受在ERCP下行十二指肠镜Oddi括约肌切开术(EST)联合LC术治疗,术后...     

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.     

两种手术方法处理腹腔镜胆囊切除术后胆总管残余结石患者临床疗效比较

目的 分析比较经内镜逆行性胰胆管造影（ERCP）下取石与开腹胆道探查（CBDE）治疗腹腔镜胆囊切除术（LC）后胆总管残余结石患者的临床疗效。方法 2015年2月~2016年12月我院收住的经LC术后存在胆总管残余结石患者84例,其中38例采取CBDE法（A组）治疗,46例采取ERCP下取石（B组）。结果 B组术中出血量明显少于A组[（3.4±1.3）ml对（124.2±65.8）ml,P<0.05],手术时间[（34.8±4.2）min对（123.3±15.8）min,P<0.05]、术后排气时间[（1.0±0.7）h对（42.6±9.1）h,P<0.05]和住院时间[（4.9±3.5）d对（9.3±4.3）d,P<0.05]均明显短于A组;术后1 w,B组血清GGT水平为（63.7±7.5）IU/L,与A组的（70.2±7.9）IU/L 比无显著性相差（P>0.05）,血清ALP水平为（105.6±11.5）IU/L,与A组的（115.4±12.8）IU/L比无显著性相差（P>0.05）;A组并发症发生率为23.7%、结石再复发率为5.3%,而B组分别为15.2%和6.5%,两组比较无显著性差异（P>0.05）。结论 相对于CBDE术,采用ERCP下取石处理经LC术后胆总管残余结石患者可有效降低术中出血量,缩短手术时间,并因可反复进行而具有优势。     

Laparoscopic C-tube drainage via cystic duct following common bile duct exploration

Laparoscopic common bile duct (CBD) exploration has come into practice with the development of laparoscopic techniques and instrumentation. However, the use of a T-tube for biliary drainage lessens the advantages of laparoscopic surgery, i.e., short hospital stay and good cosmesis. We have performed CBD exploration by laparoscopic chledochotomy followed by transcystic biliary drainage using a 6 French vinyl tube (C-tube) instead of a T-tube and primary closure of the choledochotomy. The C-tube could be removed within 7 days postoperatively because the cystic duct was ligated with an elastic thread. Twelve patients with CBD stones were successfully treated by this new technique and there was no morbidity attributable to the procedure.     

Two-stage vs single-stage management for concomitant gallstones and common bile duct stones

AIM: To evaluate the safety and effectiveness of two-stage vs single-stage management for concomitant gallstones and common bile duct stones.METHODS: Four databases, including PubMed, Embase, the Cochrane Central Register of Controlled Trials and the Science Citation Index up to September 2011, were searched to identify all randomized controlled trials (RCTs). Data were extracted from the studies by two independent reviewers. The primary outcomes were stone clearance from the common bile duct, postoperative morbidity and mortality. The secondary outcomes were conversion to other procedures, number of procedures per patient, length of hospital stay, total operative time, hospitalization charges, patient acceptance and quality of life scores.RESULTS: Seven eligible RCTs [five trials (n = 621) comparing preoperative endoscopic retrograde cholangiopancreatography (ERCP)/endoscopic sphincterotomy (EST) + laparoscopic cholecystectomy (LC) with LC + laparoscopic common bile duct exploration (LCBDE); two trials (n = 166) comparing postoperative ERCP/EST + LC with LC + LCBDE], composed of 787 patients in total, were included in the final analysis. The meta-analysis detected no statistically significant difference between the two groups in stone clearance from the common bile duct [risk ratios (RR) = -0.10, 95% confidence intervals (CI): -0.24 to 0.04, P = 0.17], postoperative morbidity (RR = 0.79, 95% CI: 0.58 to 1.10, P = 0.16), mortality (RR = 2.19, 95% CI: 0.33 to 14.67, P = 0.42), conversion to other procedures (RR = 1.21, 95% CI: 0.54 to 2.70, P = 0.39), length of hospital stay (MD = 0.99, 95% CI: -1.59 to 3.57, P = 0.45), total operative time (MD = 12.14, 95% CI: -1.83 to 26.10, P = 0.09). Two-stage (LC + ERCP/EST) management clearly required more procedures per patient than single-stage (LC + LCBDE) management.CONCLUSION: Single-stage management is equivalent to two-stage management but requires fewer procedures. However, patient’s condition, operator’s expertise and local resources should be taken into account in making treatment decisions.     

改良鼻胆管与普通鼻胆管引流在经胆囊入路治疗细径胆总管结石患者疗效研究

目的 探讨使用内镜下改良的鼻胆管引流(ENBD)在经胆囊入路治疗细径胆总管结石(CBDS)患者的疗效。方法 2015年12月～2018年6月我科诊治的54例细径CBDS患者(对照组),采用腹腔镜胆囊切除术(LC)后,在腹腔镜下经胆囊管行胆总管探查术,再在十二指肠镜协助下经腹顺行安置常规鼻胆管引流;2018年7月～2020年12月我科诊治的54例细径CBDS患者(观察组),手术方法同前,只是使用改良的鼻胆管进行引流。常规检测血清C反应蛋白(CRP)、白介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)。结果 观察组术后胆汁引流量和鼻胆管拔管时间分别为(281.6±52.5)mL和(5.9±1.3)d,显著多于或长于对照组【分别为(228.7±53.2)mL和(4.0±1.4)d,P<0.05],而住院日为(6.1±1.1)d,显著短于对照组[(8.1±1.3)d,P<0.05】;观察组术后并发症,如胰腺炎、胆漏和鼻胆管滑脱发生率为7.4%,显著低于对照组的25.9%(P<0.05);在术后1周,观察组血清CRP、IL-6和TNF-α水平分别为(42.8±11.1)mg...