胆总管结石2种手术方式临床效果比较

目的比较腹腔镜及胆道镜下胆囊切除术联合胆总管切开探查取石术与传统开腹胆囊切除联合胆总管切开探查取石术治疗胆总管结石的临床效果。方法将62例胆总管结石患者根据纳入时间不同分为2组。对照组(n=31)实施传统开腹胆囊切除术联合胆总管切开探查取石术治疗;研究组(n=31)行腹腔镜、胆道镜胆囊切除术联合胆总管切开探查取石术治疗。比较2组患者术后并发症发生率、住院时间、术后胃肠道功能恢复时间、结石取净率以及护理前后生活质量变化。结果研究组术后并发症发生率显著低于对照组,住院时间、术后胃肠道功能恢复时间均显著短于对照组(P 0.05);研究组结石取净率与对照组比较差异无统计学意义(P 0.05);术后,2组生活质量评分显著高于术前,且研究组评分显著高于对照组(P 0.05)。结论腹腔镜、胆道镜胆囊切除术联合胆总管切开探查取石术治疗胆总管结石的临床效果优于传统开腹胆囊切除术联合胆总管切开探查取石术,可减少并发症的发生,提高术后结石取净率以及生活质量。     

整体护理对胆囊及胆总管结石三镜联合治疗后的护理作用

目的 探讨整体护理对胆囊及胆总管结石患者三镜联合治疗后的护理效果,评价其临床价值.方法 选取胆囊及胆总管结石患者88例,随机分为对照组和观察组,每组44例.对照组采用常规护理方法,观察组采用整体护理.观察两组患者的住院时间、满意度及术后并发症情况.结果 观察组患者满意度为95.5％,对照组为78.6％ (31/44),观察组患者满意度明显高于对照组(P＜0.05);观察组患者的术后并发症发生率为6.81％,对照组为18.2％,观察组患者术后并发症发生率低于对照组(P＜0.05);观察组患者的住院时间短于对照组(P＜0.05).结论 整体护理对于胆囊及胆总管结石患者三镜联合治疗后不仅能提高患者的满意度,而且能够减少患者的住院时间及术后并发症的发生率,具有很好的临床应用价值.     

围术期护理干预对三镜联合治疗胆囊伴胆总管结石患者的影响

目的:探讨三镜联合治疗胆囊结石合并胆总管结石患者的护理方法。方法:将90例三镜联合治疗胆囊结石合并胆总管结石的患者随机分为观察者和对照组各45例,观察组接受围术期护理干预,对照组采用传统常规护理。结果:观察组手术时间、住院时间、肛门排气时间、并发症发生率显著低于对照组(P<0.05),患者满意度显著高于对照组(P<0.05)。结论:对三镜联合治疗胆囊伴胆总管结石患者实施围术期护理干预,可有效提高手术效果,降低患并发症发生率,使患者积极配合手术治疗。     

腹腔镜与胆道镜联合应用于老年胆囊结石并胆总管结石的围术期护理

目的探讨腹腔镜与胆道镜联合应用于老年胆囊结石并胆总管结石的围术期护理措施。方法选择本院相关患者80例作为研究对象,采用随机数字表分为对照组与研究组,各40例。对照组采取常规围术期护理措施,研究组在此基础上应用围术期综合护理干预。观察对比2组患者手术时间、胃肠功能恢复时间及住院时间,以及术后并发症情况。结果研究组胃肠功能恢复时间及住院时间均短于对照组(P0.05);2组手术时间比较差异无统计学意义(P0.05);研究组术后并发症的总发生率为5.0%低于对照组20.0%(P0.05)。结论腹腔镜与胆道镜联合围术期综合护理干预措施应用于老年胆囊结石并胆总管结石患者能够有效加快术后恢复速度,降低并发症发生率。     

经胆囊管胆总管探查术对胆总管结石患者结石残留率及并发症的影响

目的：探讨经胆囊管胆总管探查术对胆总管结石患者结石残留率及并发症的影响。方法：选取2017年4月~2018年4月河南鹤壁爱民医院收治的100例接受手术治疗的胆总管结石患者为研究对象,依据随机数字表法分为对照组和观察组,各50例。对照组行开腹胆总管切开取石术,观察组行内镜下经胆囊管胆总管探查取石术。对比两组手术相关指标、术后结石残留率、术后并发症。结果：与对照组相比,观察组术中出血量更少,手术时间、切口长度更短,结石残留率、并发症发生率更低,差异有统计学意义（P＜0.05）。结论：经胆囊管胆总管探查术治疗的胆总管结石患者术中出血量更少,手术时间、切口长度更短,结石残留率、并发症发生率更低,临床治疗效果更好。     

三镜联合胆总管探查术治疗胆囊伴胆总管结石的护理

目的探讨十二指肠镜、胆道镜及腹腔镜三镜联合胆总管探查术治疗胆囊伴胆总管结石患者的护理。方法回顾性分析2011年5-9月在丽水市中医院肝胆外科行三镜联合胆总管探查术的40例胆囊合并胆总管结石患者的临床资料,所有患者术前均重视心理护理、做好术前准备,并给予术后护理及预防并发症的护理。结果 40例患者均痊愈出院,无一例患者发生胆漏、残留结石等严重并发症。结论三镜联合胆总管探查术治疗胆囊合并胆总管结石是一种安全有效的微创手术方法,具有创伤小、术后恢复快等优点,而高质量的术前、术后护理是手术成功的重要保证。     

胆道镜在腹腔镜胆囊切除术治疗胆总管结石中的应用

目的探讨运用胆道镜经胆囊管途径行腹腔镜胆囊切除术治疗胆总管结石的临床意义。方法选取胆囊结石合并胆总管结石患者80例,根据手术方式的不同将其随机分为观察组和对照组,其中观察组40例患者运用胆道镜经胆囊管途径在腹腔镜胆囊切除术中治疗胆总管结石,对照组40例患者在腹腔镜胆囊切除术中行胆总管切开治疗胆总管结石。比较两组患者手术情况、术后恢复情况以及并发症的发生率。结果观察组在术中出血量、总住院时间上均比对照组少,差异有统计学意义(P0.05);观察组术后并发症的发生率显著低于对照组(P0.05)。结论运用胆道镜经胆囊管途径在腹腔镜胆囊切除术中治疗胆总管结石具有创伤小、并发症少、住院时间短等优点,值得临床推广应用。     

不同术式治疗胆囊结石合并胆总管结石患者疗效对比研究

选取我院2008年4月~2012年10月我院收治的208例胆囊结石合并胆总管结石患者。随机分为试验组105例和对照组103例。对照组患者采用传统开腹胆囊切除术,试验组患者采用小切口胆囊切除术,比较两组患者手术时间、术中出血量、肛门排气时间、切口长度、住院时间以及并发症发生情况。结果试验组术中出血量、肛门排气时间、切口长度以及住院时间均显著低于对照组,手术时间高于对照组,且差异均有统计学意义(P0.05)。试验组腹腔感染发生率低于对照组,并发症总发生率显著低于对照组,差异有统计学意义(P0.05)。治疗胆囊结石合并胆总管结石患者时小切口胆囊切除术较开腹胆囊切除术有更好的治疗效果。     

腹腔镜联合胆道镜治疗老年胆囊结石合并胆总管结石围手术期的护理干预

目的探讨围术期护理干预对腹腔镜联合胆道镜治疗老年胆囊结石合并胆总管结石患者的影响。方法回顾性分析88例老年胆囊结石合并胆总管结石患者行腹腔镜联合胆道镜行胆囊切除术胆总管切开取石术患者的临床资料,按护理方法分为干预组(44例)和对照组(44例),干预组实施围术期护理干预,对照组实施常规护理,对比观察两组患者护理效果。结果干预组的手术时间为(165.51±77.28)min,肛门排气时间(19.68±1.08)h,平均住院时间(9.21±3.27)d,并发症发生率为6.81%,护理满意度为100%,均明显好于对照组,两组对比差异具有统计学意义(P0.05)。结论老年胆总管结石患者基础病复杂,在腹腔镜联合纤维胆道镜治疗老年胆囊结石合并胆总管结石期间,实施围手术期护理干预,可取得明显的护理效果,提高手术效果,降低并发症发生率,缩短住院时间。     

快速康复外科护理在三镜联合治疗胆囊并胆总管结石中的运用

[目的]探讨快速康复外科护理在三镜联合治疗胆囊并胆总管结石的运用价值。[方法]以收治的胆囊并胆总管结石病人136例为对象,采用随机数字表法将病人分为观察组和对照组各68例,两组均行三镜联合术。对照组采用常规围术期护理,观察组予以快速康复外科护理。比较两组手术时间、术后胃肠功能恢复时间、拔管时间、胆汁引流时间、住院时间、术后并发症发生率,并在病人出院时,进行护理满意度评价。[结果]观察组术后胃肠功能恢复时间、拔管时间、胆汁引流时间和住院时间分别为(30.82±6.14)h、(4.17±1.08)d、(7.72±3.24)d、(8.11±1.73)d,均短于对照组,差异有统计学意义(t=7.773、4.283、6.218、5.990,P0.05)。观察组并发症发生率和护理满意率分别为2.94%、98.53%,均好于对照组,差异有统计学意义(χ~2=3.886、4.782,P0.05)。[结论]相比于常规围术期护理,快速康复外科护理能够改善胆囊并胆总管结石病人术后恢复状况,降低并发症发生率,提高病人护理满意度。     

腹腔镜胆总管切开取石术后胆道引流方法的改进

胆总管切开取石术后能否一期缝合的争论由来已久[1],一般认为胆总管一期缝合前须放置适当的胆道引流。我们在临床工作中探索制作了一胆道内置引流管,在腹腔镜胆总管切开取石术后用胆道内置管引流,胆总管一期缝合,效果较满意[2],现将我们的经验介绍如下。1资料与方法1.1临床资料     

Outcomes of laparoscopic bile duct exploration for choledocholithiasis with small common bile duct

BACKGROUNDLaparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct (CBD) exploration (LCBDE) is one of the main treatments for choledocholithiasis with CBD diameter of larger than 10 mm. However, for patients with small CBD (CBD diameter ≤ 8 mm), endoscopic sphincterotomy remains the preferred treatment at present, but it also has some drawbacks associated with a series of complications, such as pancreatitis, hemorrhage, cholangitis, and duodenal perforation. To date, few studies have been reported that support the feasibility and safety of LCBDE for choledocholithiasis with small CBD.AIMTo investigate the feasibility and safety of LCBDE for choledocholithiasis with small CBD.METHODSA total of 257 patients without acute cholangitis who underwent LC + LCBDE for cholecystolithiasis from January 2013 to December 2018 in one institution were reviewed. The clinical data were retrospectively collected and analyzed. According to whether the diameter of CBD was larger than 8 mm, 257 patients were divided into large CBD group (n = 146) and small CBD group (n = 111). Propensity score matching (1:1) was performed to adjust for clinical differences. The demographics, intraoperative data, short-term outcomes, and long-term follow-up outcomes for the patients were recorded and compared.RESULTSIn total, 257 patients who underwent successful LC + LCBDE were enrolled in the study, 146 had large CBD and 111 had small CBD. The median follow-up period was 39 (14-86) mo. For small CBD patients, the median CBD diameter was 0.6 cm (0.2-2.0 cm), the mean operating time was 107.2 ± 28.3 min, and the postoperative bile leak rate, rate of residual CBD stones (CBDS), CBDS recurrence rate, and CBD stenosis rate were 5.41% (6/111), 3.60% (4/111), 1.80% (2/111), and 0% (0/111), respectively; the mean postoperative hospital stay was 7.4 ± 3.6 d. For large CBD patients, the median common bile duct diameter was 1.0 cm (0.3-3.0 cm), the mean operating time was 115.7 ± 32.0 min, and the postoperative bile leak rate, rate of residual CBDS, CBDS recurrence rate, and CBD stenosis rate were 5.41% (9/146), 1.37% (2/146), 6.85% (10/146), and 0% (0/146), respectively; the mean postoperative hospital stay was 7.7 ± 2.7 d. After propensity score matching, 184 patients remained, and all preoperative covariates except diameter of CBD stones were balanced. Postoperative bile leak occurred in 11 patients overall (5.98%), and no difference was found between the small CBD group (4.35%, 4/92) and the large CBD group (7.61%, 7/92). The incidence of CBDS recurrence did not differ significantly between the small CBD group (2.17%, 2/92) and the large CBD group (6.52%, 6/92).CONCLUSIONLC + LCBDE is safe and feasible for choledocholithiasis patients with small CBD and did not increase the postoperative bile leak rate compared with chole-docholithiasis patients with large CBD.     

Primary common bile duct carcinoid

Endoscopic retrograde cholangiography was performed in a 32-year-old man with recurrent episodes of painless jaundice. There was demonstration of a large intraluminal mass causing partial obstruction of the common bile duct. The lesion proved to be a primary carcinoid tumor of the bile duct.     

Transcystic duct treatment of common bile duct stones

Successful removal of 2 retained common bile duct stones following cholecystostomy is described. With the use of the steerable catheter and the wire basket, one stone was crushed and the second was extracted in retrograde fashion through the cystic duct and gallbladder.     

Cyst of the common bile duct with acute abdomen

Congenital cysts of the bile duct are well-documented anomalies of the biliary tree. Choledochal cysts frequently cause malignant changes in the epithelial lining. In such patients, the prognosis is very poor mainly because of the lack of typical symptoms in the early stages. The incidence of carcinoma in patients with bile duct cysts is estimated at 2.5 % to 15 %, compared to an incidence of 0.012 % to 0.48 % in patients without bile duct cysts. We report the case of a 32-year-old Vietnamese woman with a history of acute epigastric pain. Exploratory surgery was performed, and the segment containing the cyst and the ectopic pancreas was resected. Sonography pointed the way, and resection would have been necessary even without the abdominal symptoms.     

Common bile duct diameters after endoscopic sphincterotomy in patients with common bile duct stones: ultrasonographic evaluation

Background: One of the most reliable, frequently used imaging techniques in cholestasis is ultrasonography (US) for the diagnosis of common bile duct (CBD) stones. Methods: In this study, changes in diameters of CBD were determined ultrasonographically before and after endoscopic sphincterotomy (ES) in 46 patients with stone-induced dilated CBD. Results: There was a significant decrease in CBD diameter measured 1 week after ES and extraction of stone (p < 0.001). In 87% of cases, the difference was more significantly pronounced during the first 24 h of ES. The mean CBD diameters on US were 13.70 ± 3.00 mm (10–21 mm) before and 9.13 ± 2.90 mm (4.2–18 mm) 24 h after endoscopic treatment (p < 0.001). After ES, six patients (13%) with inadequate decreases in CBD diameters were found to have residual stones. Conclusion: US can show residual stones in the CBD with the same efficacy as endoscopic retrograde cholangiopancreatography.     

不同方式的腹腔镜胆道探查术治疗胆总管结石的临床前瞻性研究

目的通过比较分析腹腔镜下经胆囊管和经胆总管切开T管引流及胆管一期缝合胆道镜取石治疗胆囊结石继发胆总管结石病人的疗效,以评价各种腹腔镜胆道探查方式治疗胆总管结石的临床价值。方法自2000年1月￣2003年6月根据4项筛选标准,对符合条件的61例病人按胆道探查途径不同分为经胆囊管组(n=14)和胆总管切开组,后者又分为胆总管一期缝合组(n=23)和T管引流组(n=24)。比较观察3组病例的手术时间、腹腔引流时间、术后住院日、恢复正常工作时间、术后平均输液量、住院费用、手术并发症及术后随访结果。结果经胆囊管组手术时间明显短于一期缝合组和T管引流组(P<0.05),T管引流组腹腔引流时间、术后住院日、恢复正常工作时间、术后平均输液量、住院费用明显长于或高于经胆囊管组和一期缝合组(P<0.05),而经胆囊管组和一期缝合组除手术时间外其他指标无明显差异(P>0.05)。经胆囊管组出现手术并发症1例(7.1%),一期缝合组出现手术并发症3例(13.0%),均为胆道并发症;T管引流组出现手术并发症7例(29.2%),其中胆道并发症5例(20.8%)。3组患者随访结果无明显差异。结论经胆囊管途径的腹腔镜胆道探查术治疗适合的胆囊结石继发胆总管结石病人的疗效优于胆管切开途径的腹腔镜胆道探查术,而后者中胆管一期缝合的疗效又明显优与T管引流。