同期三镜、扩张导管、气囊鼻胆管治疗胆结石、乳头部梗阻59例

目的探讨同期三镜(腹腔镜、胆管镜、十二指肠镜)、扩张导管(逐级扩张导管、球囊导管)、气囊鼻胆管(LCDND)治疗胆囊结石、胆总管结石、合并十二指肠乳头部梗阻的可行性。方法回顾性分析2010年11月至2016年12月期间,符合入选标准的59例胆囊结石、胆总管结石、合并十二指肠乳头部梗阻患者的临床资料。结果腹腔镜下切除胆囊、胆管镜探查取石59例。逐级导管扩张乳头并留置气囊鼻胆管71.2%(42/59),球囊导管扩张乳头并留置气囊鼻胆管3.4%(2/59),球囊导管取石和扩张乳头并留置气囊鼻胆管3.4%(2/59),十二指肠镜乳头切开并留置气囊鼻胆管20.3%(12/59),中转为开腹胆总管探查取石并留置T形管1.7%(1/59)。术后无残石,胆汁漏2例(3.4%),轻症胰腺炎1例(1.7%)。无肠穿孔、胆管穿孔、大出血、重症胰腺炎等并发症,无死亡。术后总并发症发生率为5.1%(3/59)。结论从本研究对本医院有限病例进行初步研究发现,只要病例选择合适,LCDND治疗胆囊结石、胆总管结石、合并十二指肠乳头部梗阻是可行、有效和安全的。

Laparoscopy,choledochoscopy, duodenoscopy,dilatable catheter and balloon nasobiliary drainage of the same period in treatment of bile duct stones with obstruction of papillory: a report of 59 cases

Objective To explore the surgical technique and clinical effect of combination of laparoscopy, choledochoscopy, duodenoscopy, dilatable catheter and balloon nasobiliary drainage (LCDND) of the corresponding period in treatment of extrahepatic bile duct stones with obstruction of papillory during the course of therapeutic laparoscopy . Methods The clinical data of 59 cases of extrahepatic bile duct stones with obstruction of papillory undergoing LCDND were analyzed retrospectively from November 2010 to December 2016 in the Second People,s Hospital of Chengdu. Results It was applied in 59 cases removed the gallbladder by laparoscopy and to remove gallstones with choledochoscopy .Step by step dilatable catheter expand duodenal papilla and indwelling nasobiliary was in 71.2%(42 /59), with balloon catheter expand duodenal papilla and indwelling balloon nasobiliary was in 3.4%(2 /59), with balloon catheter to remove gallstones and expand duodenal papilla and indwelling balloon nasobiliary was in 3.4% ( 2/59), with duodenoscopic papillary sphincterotomy and indwelling balloon nasobiliary was in in 20.3%(12 /59), it were shifted to open CBD exploration and indwelling T shape tube drainage in 1.7%(1 /59).It had not residual stones.Bile leakage occurred in 2 cases (3.4%) postoperatively, the slight pancreatitis in one case (1.7%).No cases had perforation of intestine and bile duct , bleeding, severe pancreatitis and death .Total postoperative complication formation rate is 5.1%(3 /59). Conclusion From preliminary results of limited cases in this study in our hospital , when patients of extrahepatic bile duct stones with obstruction of papillory are indicated, LCDND is safe and effective.