胆囊结石并胆源性胰腺炎的腹腔镜治疗

目的探讨胆囊结石并胆源性胰腺炎的腹腔镜治疗方法。方法在腹腔镜下游离胆总管,胆囊管近壶腹端夹闭,在其夹闭的下端将胆囊管剪一侧孔,检查胆囊管内有无结石,如有结石,将结石挤出,从胆囊管侧孔中插入一直径约2mm的引流管,行胆道造影,证实胆道无结石,胆总管下端通畅,胆囊管引流管用弹力线双重结扎固定,检查引流管有胆汁流出,引流通畅,结束手术。术后淀粉酶恢复正常,拔除胆囊管引流管,观察1、2d出院。结果该组31例病人,术前均有不同程度的血尿淀粉酶升高,术后1￣5d血淀粉酶恢复正常,腹部症状及体征消失,拔除胆囊管引流管,无胆漏发生。结论腹腔镜胆囊切除、经胆囊管胆总管引流是治疗胆囊结石并胆源性胰腺炎的有效方法。它可以有效地进行胆总管减压引流,防止胰腺炎加重,促进胰腺炎病人的康复。3￣5d拔除胆囊管引流管后,胆囊管弹力回缩自动关闭,不会出现胆漏。因无需切开胆总管置T型管引流,大大缩短了住院、带管时间,减轻了病人痛苦。

Laparoscopic treatment in mild gallstone pancreatitis

Objective] To discuss the method of laparoscopic treatment in mild gallstone pancreatitis. Method] Common bile duct was dissociated and cystic duct closed to ampulla was occluded by clip. Lateral incision of cystic duct was made and drainage tube with a diameter of 2 mm was inserted. If cholangiography showed that there was no existing bile stone and the end of common bile duct was unobstructed, the drainage tube was fixed . If the bile drainage was good, the operation could be finished. Post operation, drainage tube might be pulled out after blood and urine amylase were normal and the patients were discharged 1 or 2 days later. Results] 31 cases of gallstone pancreatitis were treated, and all these patients were diagnosed as mild gallstone pancreatitis. From 1 to 5 days after operation, blood amylase became normal, symptoms disappeared, and bile leakage did not happen in all cases. Conclusion] Gallstone pancreatitis can be effectively treated by laparoscopic cholecystectomy and bile duct drainage through cystic duct. It can effectively relieve pressure of the common bile duct, prevent pancreatitis from deteriorating and stimulate recovery. Lateral incision of cystic duct will closed because of its elastic contraction and bile leakage does not happen. Without common bile duct discussion, hospitalization and drainage time will be shortened and patients suffering will be relieved.