摘要
目的:探讨腹腔镜下逆向十二指肠乳头插管取石术治疗胆囊结石伴细径胆总管结石的临床疗效及安全性。方法:选取2016年7月至2018年5月收治的118例胆囊结石伴细径胆总管结石患者,以1:1匹配方式分为对照组(n=59)与试验组(n=59),分别采用腹腔镜联合十二指肠镜取石术及在此基础上行逆向十二指肠乳头插管取石术;比较两组插管效果、术中与术后临床指标水平、手术前后实验室指标水平及术后并发症发生率。结果:试验组插管效果优于对照组(P<0.05),手术时间、术后胃肠功能恢复时间、总住院时间短于对照组(P<0.05);两组手术前后ALT、AST、TBIL水平差异无统计学意义(P>0.05);试验组患者术后血清淀粉酶及血清脂肪酶水平均低于对照组(P<0.05);两组患者术后并发症发生率差异无统计学意义(P>0.05)。结论:相较腹腔镜联合十二指肠镜取石术,腹腔镜下逆向十二指肠乳头插管取石术治疗胆囊结石伴细径胆总管结石可有效提高插管效果,降低操作难度,促进早期康复,有助于减轻胰腺损伤。
Objective:To investigate the clinical efficacy and safety of laparoscopic reversed duodenal papillary intubation for the treatment of gallstones with small diameter common bile duct stones.Methods:One hundred and eighteen patients with cholecystolithiasis complicated with small diameter common bile duct stones from Jul.2016 to May 2018 were divided into control group ( 59 patients) and experimental group ( 59 patients).Laparoscopy and duodenoscopy combined with stone removal in control group and retrograde duodenal papillary intubation in experimental group were performed.The intubation effect,intraoperative and postoperative clinical indicators,laboratory indicators before and after surgery and the incidence of postoperative complications were compared between the two groups.Results:The intubation effect of experimental group was significantly better than that of control group ( P<0.05).The operation time,the first exhaust time after operation and hospital stay of experimental group were significantly shorter than those of control group ( P<0.05).There was no significant difference in the levels of ALT,AST and TBIL level before and after operation between the two groups ( P>0.05).The levels of serum amylase and serum lipase after operation in experimental group were significantly lower than those in control group ( P<0.05).There was no significant difference in the complications incidence between the two groups ( P>0.05). Conclusions:Compared with laparoscopy combined with duodenoscopy,laparoscopic reversed duodenal papillary intubation in the treatment of gallbladder stones with small diameter common bile duct stones can effectively improve the intubation effect,reduce the difficulty of operation,promote early rehabilitation and is conducive to reducing pancreatic damage.
作者
程相超
袁启东
赵建红
张家明
CHENG Xiang-chao;YUAN Qi-dong;ZHAO Jian-hong(Department of General Surgery,the Third People's Hospital of Henan Province,Zhengzhou 450017,China)
出处
《腹腔镜外科杂志》
2019年第6期419-422,共4页
Journal of Laparoscopic Surgery
