腹腔镜胆总管探查术中十二指肠镜下乳头切开术49例报告

目的探讨腹腔镜胆总管探查术中十二指肠镜下乳头切开术治疗十二指肠乳头狭窄的手术方法和适应证。方法腹腔镜下行胆囊切除和胆总管切开探查术,经胆总管切口插入输尿管导管或斑马导丝至十二指肠腔,经口插入十二指肠镜至十二指肠乳头,针式刀或弓式刀在输尿管导管或斑马导丝指引下对乳头施行切开术。结果施行术中十二指肠镜下乳头切开术49例,47例乳头狭窄切开成功,2例中转为其他术式。术后轻症胰腺炎1例。无肠穿孔、胆管穿孔、大出血、重症胰腺炎等严重并发症,无死亡。结论只要选择合适的患者,腹腔镜胆总管探查术中十二指肠镜下乳头切开术是可行、有效、安全。

Duodenoscopic papillotomy during the course of laparoscopic common bile duct exploration:a report of 49 cases

Objective To explore the operation methods and indications of duodenoscopic papillotomy during the course of laparoscopic common bile duct exploration（LEPT）. Methods To accomplish cholecystectomy and common bile duct exploration,through ureteric catheter and zebra guidewire into the common bile duct and duodenum ,through duodenoscopy via oral into the papillary of duodenum,were used to cut through the stenosis of papillary for electro-knife by pin-head-like and arch-like to track along the ureteric catheter and zebra guidewire. Results LEPT was successful in 47out of 49 cases. Two cases were shifted to other operation. One patient was a slight pancreatitis. No cases had perforation of intestine and bile duct, bleeding, severe pan- ereatitis and death. Conclusion If patients are suitable, LEPT is safe and effective in the hands of skilled endoscopiests.