腹腔镜胆总管支架术在胰腺癌胆管梗阻治疗中的应用

目的:探讨经腹腔镜下胆总管内置支架治疗胰腺癌胆管梗阻的手术方法及并发症的观察与护理。方法:1999~2007年采用腹腔镜胆总管探查术(LCDE)结合斑马导丝、胆管扩张导管、塑料胆管支架和自膨式金属胆管支架施行腹腔镜胆总管支架术(LCBDS)37例。结果:37例转移病灶取标本中26例病理报告胰腺癌,11例未证实。37例中29例手术获成功(胆总管支架通畅、黄疸减轻或消退),7例中转开腹,1例术后15天死于胆管感染诱发肝肾功能衰竭。结论:选择合适病例,采用腹腔镜胆总管支架术处理胰腺癌胆管梗阻是一种有效、安全、简便、可行的术式。充分的术前准备,准确的手术操作,术后严密的病情观察及针对性的护理是保证手术成功的关键。

Application of Laparoscopic Common Bile Duct Stent in the Treatment for Bile Duct Obstruction of Pancreatic Carcinoma:Report of 37 Cases

Objective:To discuss the operation and observation and complications of patients with obstruction of bile duct in pancreatic carcinoma treated by laparoscopic common bile duct stent(LCBDS).Methods:From 1999 to 2007,LCBDS was performed by using laparoscopic common bile duct exploration(LCDE),zebra guidewire,dilatation catheter and bile duct stent.Results:Pancretic cancer cells in the site of metastasis were detected in 26 out of 37 patients.Twenty-nine in 37 patients had completedly successful duct drainage.Seven patient received open abdominal operation.One patient died of the functional failure of liver and kidneys on the 15th days after operation.Conclusion:It was effective,safe,simple and practicable to use LCBDS for bile duct obstruction in pancreatic carcinoma.The key point to ensure the operation being successfal included sufficient pre-operative preparation,accurate operation,careful post-operative observation and pertinent nursing care.