同期三镜、鼻胆管引流选择性治疗急性胆源性胰腺炎92例

目的探讨同期三镜(腹腔镜、胆管镜、十二指肠镜)、鼻胆管引流术(LCDND)选择性治疗胆囊结石、胆总管结石合并急性胆源性胰腺炎的应用体会。方法回顾性分析2010年4月至2016年9月期间,符合入选标准的92例胆囊结石继发胆总管结石合并急性胆源性胰腺炎患者的临床资料。先游离胆囊至胆总管汇合部,经胆囊管汇合部切开或胆总管前壁切开,采用胆管镜取石网取石或液电碎石术;经胆管切口插入引导管进入肠腔,引导十二指肠镜行乳头切开术和鼻胆管引流术;结石取净后,行胆管切口的一期缝合术,切除胆囊。结果腹腔镜下切除胆囊、胆管镜探查、内镜乳头切开92例。胆管镜取石后留置鼻胆管82.6%(76/92),胆管镜联合十二指肠镜取石后留置鼻胆管9.8%(9/92),因胆总管残石而腹腔镜下留置T形管2.2%(2/92),因乳头狭窄未解除留置鼻胆管失败而腹腔镜下留置输尿管导管3.3%(3/92),因腹腔镜下取石失败而中转为开腹胆总管探查取石术并留置鼻胆管2.2%(2/92)。术后发现残石1例(1.1%),胆汁漏3例(3.3%),应激性溃疡出血3例(3.3%)。无肠穿孔、胆管穿孔、重症胰腺炎等并发症,无死亡。术后总并发症发生率为7.6%(7/92)。结论初步研究发现,只要病例选择合适,同期三镜、鼻胆管引流术治疗胆囊结石、胆总管结石合并急性胆源性胰腺炎是可行、有效和安全的。

Clinical combined application of laparoscopy,choledochoscopy, duodenoscopy,and nasalbiliary drainage for selective treatment of acute biliary pancreatitis during the course of therapeutic laparoscopy:a report of 92 cases

Objective To explore the surgical technique and clinical effect of emergency laparoscopy , choledochoscopy , duodenoscopy and nasobiliary drainage ( LCDND ) for selective treatment of acute biliary pancreatitis . Methods The clinical data of 92 cases of acute biliary pancreatitis of cholecystolithiasis with choledocholith undergoing LCDND were analyzed retrospectively from April 2010 to September 2016 in the Second People,s Hospital of Chengdu.First dissociated the gallbladder to the CBD confluence , via the cystic duct confluence incision or incision of the CBD , the stone was removed by choledochoscopy or electrohydraulic lithotripsy .Then inserted the tube into the intestinal lumen .Endoscopic papillary sphincterotomy and nasobiliary drainage were proformed .After removing the stones , the incision of the CBD were performed primary suture , and to remove the gallbladder . Results It was applied in 92 cases removed the gallbladder by laparoscopy and to remove gallstones with choledochoscopy and performed endoscopic papillary dissection with duodenoscopy .Through the duct incision by choledochoscopy to remove gallstones and indwelling nasobiliary was in 82.6% (76/92), through choledochoscopy and duodenoscopy to remove gallstones and indwelling nasobiliary was in 9.8% (9/92), via choledochoscopic examination indwelling T shape tube drainage due to residual stone of CBD was in 2.2% (2/92), via choledochoscopy to remove gallstones and indwelling ureteric catheter drainage due to the stenosis of papillary was not released in 3.3% (3/92), it were shifted to open CBD exploration for the stone removal and indwelling nasobiliary in 2.2% (2/92).Postoperative residual stone occurred in 1 cases (1.1%), bile leakage in 3 cases (3.3%), stress ulcer hemorrhage in 3 cases (3.3%).Total postoperative complication formation rate is 7.6%(7/92).No cases of perforation of intestine and bile duct , bleeding, severe pancreatitis and death was occurred . Conclusion From preliminary results of limited cases in this study in our hospital , when patients of gallstone acute pancreatitis are indicated , LCDND is safe and effective .