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胆总管末端结石64例分析

nalysis on Clinical Effects of Different Operations for Treating Gallbladder and Bile Duct Stones

目的探讨腹腔镜联合胆道镜治疗胆囊及胆总管结石的临床疗效。 方法回顾性分析2010年1月至2013年1月期间收治于笔者所在科室的96例胆囊及胆总管结石患者的临床资料，根据手术方式分为开腹组、腹腔镜联合胆道镜＋T管引流术组和腹腔镜联合胆道镜＋放置鼻胆管一期缝合组3组。对3组患者的手术时间、术中出血量、肛门排气时间、住院时间、残石率、复发率、并发症发生率、手术有效率及术后淀粉酶和肝功能指标水平进行对比分析。 结果微创手术组与开腹组比较，患者的出血量、肛门排气时间、住院时间、残石率、复发率及并发症发生率均减少、缩短或降低，同时手术的有效率提高（P＜0.05）；腹腔镜联合胆道镜＋放置鼻胆管一期缝合组术后淀粉酶和肝功能指标的水平较其他2组明显降低（P＜0.05）。 结论微创手术创伤小，残石率及复发率低，并发症少，患者术后恢复快，是一种安全有效的治疗方式，值得临床推广应用。

Treatment with Miniature Incision at the End of Bile Duct of Stone（Report of 110 Cases）

目的探讨小切口胆总管末端结石的治疗。方法对110例胆总管末端结石患者采用小切口术中胆道镜、气囊导管等治疗的临床资料进行回顾性总结。结果术中采用胆道镜、气囊导管等清除末端结石86例（78.2%）。术后用胆道镜取出结石10例（9.1%），胆道镜联合内镜乳头括约肌切开技术清除结石14例（12.7%）。术中18例(16.4%）并发胆总管末端医源性损伤，其中1例术后并发消化道大出血死亡，其余病例经2~20年随访无远期并发症。结论胆总管末端结石采用小切口术中胆道镜、气囊导管等相结合能清除多数结石，难以取出的末端结石于术后经内镜处理为妥。

Clinical Experience of Laparoscopic Choledocholithotomy and Primary Suture: a Report of 58 Cases

ObjectiveTo explore the clinical efficacy and surgical techniques of laparoscopic choledocholithotomy and primary suture. MethodsWe retrospectively analyzed the clinical data of 58 patients who underwent laparoscopic choledocholithotomy and primary suture between January 2009 and December 2014. ResultsAll the 58 patients underwent the surgery successfully. Operation time was 45-125 minutes, averaging 75 minutes. Intraoperative blood loss was between 10 and 50 mL with an average of 20 mL. Postoperative hospital stay was 5-14 days with an average of 7 days. Four cases of biliary leakage were cured by conservative treatment. ConclusionWith operation indications strictly grasped and skillful operation techniques, laparoscopic choledocholithotomy and primary suture are safe and reliable with a good curative effect.

Clinical Study of Laparoscopic Common Bile Duct Exploration with Primary Suture

【摘要】　目的　探讨腹腔镜胆总管探查一期缝合的可行性和适应证及临床价值。　方法　回顾性分析2007年7月—2010年10月72例胆管结石患者的临床资料，采用三孔法腹腔镜胆总管探查术，术中胆道镜配合胆道手术器械取石，一期缝合胆总管进行治疗。　结果　72例手术均获成功，无中转开腹，4例出现术后胆漏，经腹腔引流3~5 d治愈，无严重并发症。术后住院4~7 d（平均4.4 d）。72例均获随访，随访时间1~24个月（平均10个月）。术后1个月B型超声，未发现胆道狭窄及残余结石。　结论　腹腔镜胆总管探查术后一期缝合胆总管，安全、有效、微创效果显著，是临床微创治疗胆囊结石合并胆管结石的一种理想术式，值得临床推广应用。其关键是术中取尽结石和把握适应证，同时需要术者熟练掌握胆道镜技术及腹腔镜下胆总管切开缝合、打结等技术。【Abstract】　Objective　To discuss the feasibility, indications and clinical value of laparoscopic common bile duct exploration with primary suture.　Methods　We analyzed the clinical data of 72 patients with biliary duct stone treated from July 2007 to October 2010. Three-port laparoscopic common bile duct exploration with primary suture was adopted; choledochoscopy and open bile duct operation instruments were used to take out the stones during the operation; and the common bile duct was treated with primary suture after operation.　Results　All operations were carried out successfully without any case of conversion to open operation. Bile leakage occurred in four cases and was cured with abdominal drainage tube for three to five days without any severe complications. Postoperative hospitalization time ranged from four to seven days, averaging at 4.4 days. All patients were followed up for one to 24 months (averaging at 10 months). B-mode ultrasonography examination one month after operation showed no biliary tract stricture or residual stone.　Conclusions　Laparoscopic common bile duct exploration with primary suture is safe, reliable, minimally invasive, more effective, and can be regarded as an ideal operative method for the treatment of cholecystolithiasis combined with biliary duct stone in clinical practices. It is worth popularizing. The key elements for a successful operation lie in completely taking out the stones and having a sound knowledge of indications. Furthermore, surgeons should master the skills in choledochoscopy techniques, laparoscopic incision, suture and ligation.

Application of Laparoscope in Biliary Reoperation

目的探讨腹腔镜胆道再次手术的适应证、手术方法及临床效果。方法回顾性分析我院2003年2月至2010年11月期间46例腹腔镜胆道再次手术患者的临床资料，对术中及术后结果进行总结。结果本组45例在腹腔镜下完成手术，1例中转开腹。手术时间为45～270 min(平均120 min)，残株胆囊切除时间为(40±10) min，胆总管切开取石+T管引流时间为(150±50) min，胆总管切开取石+等离子碎石+T管引流时间为(180±40) min，术后出血及漏胆腹腔镜探查术时间为（40±15）min。结石一次性取尽23例，术后残余结石2例，住院4～21 d，平均8.6 d。胆管残余结石患者在术后1个月后经T管瘘道用胆道镜取石。术中十二指肠球部损伤3例，及时发现修补; 术后出现右侧胸腔积液4例、肺部感染2例和漏胆1例，均经非手术治疗痊愈。术后电话随访6～24个月（平均15个月），未见异常。结论腹腔镜胆道再次手术可行，并具有创伤小、恢复快等优点，但术前应严格掌握手术适应证，对手术医生的技术要求也较高。

Surgical Treatment of Congenital Choledochal Cyst (Report of 145 Cases)

Objective To present the surgical treatment experiences of congenital choledochal cyst (CCC). MethodsOne hundred and fortyfive patients in 152 CCC were analyzed retrospectively and followed in west China hospital of Sichuan university from 1964 to 1999. ResultsOne hundred and fortyfive cases underwent operation and 6 of them died after operation. The incidence of hepatocirrhosis within first year after birth is higher than those over one year old （P＜0.05）. Thirtynine cases underwent cystoduodenostomy or cystojejunostomy. One hundred and six children underwent cyst resection and biliary tract reconstruction (with single RouxY hepaticojejunostomy 48 cases, intussusceptive valve and rectangular valve to the line of RouxY hepaticojejunostomy 37 and 21 cases respectively). Seventyseven patients were followedup (means 4.68 years). Two of 3 cases with ascending cholangitis after single RouxY hepaticojejunostomy underwent reoperations with an intussusceptive valve added to the line of RouxY hepaticojejunostomy and the symptoms disappeared. All of them have a good outcome. Conclusion The younger the patients, the less severe the liver damaged, and its prognosis are better. The procedure that cyst resection totally and an intussusceptive valve added to the line of RouxY hepaticojejunostomy should be carried out early as soon as possible.

胆囊切除术后钛夹移位至胆总管致急性胰腺炎1例报道

ENHANCEMENT OF RESULT IN CYSTECTOMY，RECONSTRUCTION OF BILE DUCT BY THE USE OF A ROUX LOOP OF JEJUNUM

目的为提高胆总管囊肿切除、胆肠RouxY吻合术的疗效，对其影响疗效的相关因素进行经验总结。方法对我院收治的34例小儿先天性胆总管囊肿进行回顾性分析。结果31例施行了手术，术后随访通过B超、X线胃肠钡餐检查表明30例治愈，疗效满意，1例新生儿术后并发吻合口漏死亡。手术治愈率96.8%，手术死亡率3.2%。结论为提高本术式的疗效，术前的B超、CT扫描以及术中的胆道造影，ERCP检查对判定本病类型，有无胰胆管合流异常，对选择手术方法和疗效有帮助，此外注意囊肿的病理改变及手术技术对提高疗效，减少并发症的发生也是十分重要的。

Analysis of Effect and Quality of Laparoscopic Cholecystectomy with Common Bile Duct Exploration，Built-in-Tube Drainage, and Primary Suture

ObjectiveTo compare and evaluate the effect and quality of T-tube drainage and bulit-in-tube drainage plus primary suture after laparoscopic cholecystectomy (LC). MethodsA clinical trial was taken in 79 cases with T-tube drainage (control group) and 62 cases with built-in-tube drainage (observation group). The treatment success rate, incidence of complications, bilirubin recovered time, length of stay, recuperation time, and treatment cost were measured and compared between the two groups. ResultsThere were no statistically significant differences between the two groups in treatment success rate, incidences of complications, and bilirubin recovered time of patients （Pgt;0.05）, while length of stay, recuperation time, and treatment cost of patients in observation group were significantly less than those in control group （Plt;0.05）. ConclusionsBuilt-in-tube drainage plus primary suture after LC and common bile duct exploration could achieve the same therapeutic effect as the traditional T-tube drainage with less length of stay, recuperation time, and treatment cost.