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《世界华人消化杂志》2016,(26)
肝内外胆管结石是一种常见、多发疾病,其传统的开腹手术近年来受到微创手术的挑战.本文通过文献检索,结合作者的实践经验,在全面总结肝内、外胆管结石的微创治疗现状基础上,探讨出一种可有效提高其微创治疗效果的策略:(1)对于肝内胆管结石:可根据指征选用腹腔镜肝切除、腹腔镜胆总管探查取石术(laparoscopic common bile duct exploration,LCBDE)、经皮经肝胆道镜取石术;(2)对于胆囊结石合并胆总管结石:可根据指征选用腹腔镜胆囊切除(laparoscopic cholecystectomy,LC)+经内镜十二指肠乳头括约肌切开(endoscopic sphincterotomy,EST)或经内镜乳头气囊扩张术(endoscopic papillary balloon dilatation,E P B D)、L C+经胆囊管胆总管探查取石术(laparoscopic transcystic common bile duct exploration,LTCBDE)、LC+LCBDE+T管引流或一期缝合术;(3)对于肝内合并肝外胆管结石,可根据指征选用腹腔镜肝切除、经肝断面胆管胆道镜取石、LCBDE、EST、经皮经肝胆道镜碎石术.根据上述策略,结合术者的技术和设备条件,合理选择微创治疗方法,对于提高肝内、外胆管结石的治疗效果具有重要意义. 相似文献
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《世界华人消化杂志》2015,(36)
目的:探讨经皮肾镜在复杂性胆管结石中的临床应用疗效.方法:回顾性分析2013-01/2015-03在宜春市人民医院运用经皮肾镜治疗的73例复杂性胆管结石患者临床资料.所有病例术前都行B超、计算机断层扫描或者核磁共振成像确诊,排除凝血功能异常、顽固性高血压和严重脏器功能障碍的病例后,开始实施经皮肾镜取石手术.术后通过采用门诊、电话、手机短信或微信等方式进行随访,随访时间截至2015-08.结果:2013-01/2015-03在宜春市人民医院经皮肾镜联合气压弹道碎石共治疗肝内外胆管结石73例,碎石成功率达到100%.其中1次性取净结石48例(65.8%),2-3次取净结石22例(30.1%),3-4次取净结石3例(4.1%).术后l例肝内弥漫性结石女性患者经过4次经皮肾镜联合气压弹道碎石治疗.73例患者中,联合行左肝外叶切除术7例,胆肠吻合术2例.术后3例留置T管的患者术后瘘管处出血,术后腹胀呕吐2例,无其他严重并发症发生.73例患者拔除T管后随访3-12 mo,平均随访10 mo,肝内胆管结石复发率为3/73.结论:经皮肾镜治疗复杂性胆管结石具有术中术野清晰,清除结石效率高,患者手术时间短,术后恢复快,住院时间短,住院费用少等优点,是一种安全、经济、高效的手术方法. 相似文献
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经皮胆管镜治疗肝内外胆管结石的探讨 总被引:9,自引:2,他引:9
目的 探讨经皮胆管镜治疗肝内外胆管结石的疗效和结石复发的防治。方法 43例经皮经肝胆管引流和窦道扩张后,经皮经肝胆管镜(PTCS)治疗肝内外胆管结石;22例术后T管留置>3周者,行术后胆管镜(POCS)治疗。该65例中肝内胆管结石(IHS)40例(I型12例,IE型28例),胆总管结石(CBI)结石)25例。结果 43例PTCS扩张窦道直径平均19.1 F,建立窦道时间平均17.1d。65例中11例直接取石,54例行液电碎石(EHL)后取石,其中25例配合乳头括约肌切开。40例IHS至结石清除每例治疗次数平均5.2次,25例CBD结石平均1.9次。37例(56.9%)有胆管或胆肠吻合口狭窄,用探条或气囊扩张,3例留置金属支架,结石清除率98.5%(64/65)。11例合并胆道感染,1例IHS伴胆汁性肝硬化合并肾功能不全死亡。 平均随访30.8个月,结石复发率7.1%。结论 经皮胆管镜和EHL是治疗胆系结石安全、有效的办法;胆管或胆肠吻合口狭窄长度<0.5 cm者,器械扩张效果良好;治疗狭窄可提高结石清除率,降低结石复发率。 相似文献
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十二指肠镜、腹腔镜、胆道镜联合治疗胆结石(附20例报告) 总被引:1,自引:0,他引:1
目的 探讨十二指肠镜、腹腔镜、胆道镜联合治疗胆囊结石并胆总管结石的可行性与优越性.方法 选择20例胆囊结石并胆总管结石患者,先经十二指肠镜放置鼻胆管引流(ENBD)以便胆道减压,然后完成腹腔镜胆囊切除术,最后完成腹腔镜胆总管切开、胆道镜探查取石术,并一期缝合胆管.统计分析治疗结果,并发症和患者住院天数.结果 20例均痊愈,无并发症发生,住院时间缩短.结论 十二指肠镜、腹腔镜、胆道镜联合治疗胆囊结石并胆总管结石是一种创伤小、有效、安全且可靠的治疗模式.对掌握了腹腔镜下缝扎技术的普外科医师,可作为一种首选手术方法. 相似文献
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对于单用十二指肠镜难以取出的胆管结石,包括肝内胆管结石、肝外胆管巨大或多发或嵌顿结石、十二指肠乳头插管困难等,我们采用经皮穿刺胆管置鞘建立新通道,插入超细胆道镜对接十二指肠镜治疗上述患者,取得满意疗效。[第一段] 相似文献
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术中应用经皮胆镜诊治肝内胆管结石梅方雄高焱明李荣梁志鹏王和鑫肝内胆管结石往往数量多、分布广,且常合并胆管狭窄,手术取石较为困难。1991年9月至1996年9月,我院在术中应用经皮胆镜对肝内胆管结石进行诊断和治疗共103例,取得较好效果,现小结如下。一... 相似文献
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目的探讨经皮肝I期胆道造瘘(PTOBF)联合胆道镜治疗胰十二指肠切除术后继发胆管结石的安全性和有效性,探讨胰十二指肠切除术后胆肠吻合口狭窄的原因及处理对策。方法回顾性分析2017年10月至2021年5月于山东省第二人民医院接受PTOBF联合术中硬质胆道镜、术后电子胆道镜治疗的12例胰十二指肠切除术后继发胆管结石患者的临床资料。结果所有患者均成功行PTOBF,经胆道镜取净肝胆管结石,术中发现胆肠吻合口狭窄8例(线结性狭窄3例),经胆道气囊扩张及胆肠吻合口线结拆除,7例近期缓解(87.5%),1例再次胆肠吻合手术。结论PTOBF联合胆道镜治疗胰十二指肠切除术后继发胆管结石安全有效,取净率高,可缓解胆肠吻合口狭窄。 相似文献
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目的探讨经皮肝I期胆道造瘘(PTOBF)联合胆道镜治疗胰十二指肠切除术后继发胆管结石的安全性和有效性,探讨胰十二指肠切除术后胆肠吻合口狭窄的原因及处理对策。方法回顾性分析2017年10月至2021年5月于山东省第二人民医院接受PTOBF联合术中硬质胆道镜、术后电子胆道镜治疗的12例胰十二指肠切除术后继发胆管结石患者的临床资料。结果所有患者均成功行PTOBF,经胆道镜取净肝胆管结石,术中发现胆肠吻合口狭窄8例(线结性狭窄3例),经胆道气囊扩张及胆肠吻合口线结拆除,7例近期缓解(87.5%),1例再次胆肠吻合手术。结论PTOBF联合胆道镜治疗胰十二指肠切除术后继发胆管结石安全有效,取净率高,可缓解胆肠吻合口狭窄。 相似文献
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Jun Kadono Koro Sakoda Mineo Tabata Juro Mizouchi Masahiko Osako Hiroshi Shibuya Tamiharu Utsunomiya Hitoshi Uchizono Atsumasa Yamaguchi Takeshi Shimizu 《Journal of hepato-biliary-pancreatic sciences》2005,12(5):419-421
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. 相似文献
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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. 相似文献
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Sakai Y Ishihara T Tsuyuguchi T Tawada K Saito M Kurosawa J Tamura R Togo S Mikata R Tada M Yokosuka O 《World journal of gastrointestinal endoscopy》2011,3(11):231-234
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"). 相似文献
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Beaussier M Wendum D Fouassier L Rey C Barbu V Lasnier E Lienhart A Scoazec JY Rosmorduc O Housset C 《Journal of hepatology》2005,42(2):257-265
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
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Schofield A Hankins J Sutherland F 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2003,5(4):261-263
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. 相似文献
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Drug-induced bile duct injury related prolonged or chronic cholestasis is recognized as a common side effect of treatment with several drugs. The severity and duration of the clinical symptoms suggest that this increase in number of reports is not only related to clinician and pathologists being increasingly aware of the condition, but also may represent a true increase in incidence likely related to a time-related growing experience with newer drugs. This clinical presentation encompasses a wide variety of features that may be the source of diagnostic difficulties, especially in the cases where cholestasis occurs days or weeks after the completion of therapy. Even more puzzling is the initial picture of hepatocholangitis, which may be silent and ensuing bile duct paucity with chronic anicteric cholestasis may be another source of diagnostic difficulties in the long-term. These diagnostic difficulties suggest that some of the cases of the so-called "idiopathic adulthood ductopenia" may originate from overlooked drug induced vanishing bile duct syndrome. The pathogenesis of the syndrome remains largely unknown and the determinants of prognosis and outcome. From reproducible data obtained in different studies investigating HLA-dependent predisposition, one may assume that genetics plays a major role even if other unknown additive factors are also likely involved. Severity of initial hepatocholangitis is likely to represent another important determinant of severity and prognosis, however to be assessed in larger longitudinal studies. Therapy of large bile duct injury mimics that of primary sclerosing cholangitis. Treatment of small bile duct injury remains disappointing. Corticosteroids are invariably ineffective. Ursodeoxycholic acid as been shown to induce improvement of clinical and biochemical cholestasis in some selected cases, its efficacy being however unpredictable. Preliminary data about the natural history of the vanishing bile duct syndrome suggest that therapy might be more effective when initiated early. 相似文献