肝外膽管結(jié)石三種手術(shù)治療模式的臨床療效比較
發(fā)布時(shí)間：2019-03-14 15:03
【摘要】：膽管結(jié)石是肝膽胰外科的常見病及多發(fā)病,最新研究表明,膽囊結(jié)石發(fā)病占79.9%；肝外膽管結(jié)石合并膽囊結(jié)石發(fā)病占9.2%；肝外膽管結(jié)石占6.2%。據(jù)統(tǒng)計(jì),在西方國家,膽結(jié)石的發(fā)病率約為10%-40%,且主要為膽囊結(jié)石；而在東方國家,其發(fā)病率約為2%-6%,近年來膽石癥的發(fā)病率呈逐漸上升趨勢[1、2]。大多數(shù)膽管結(jié)石都會(huì)出現(xiàn)發(fā)熱、腹痛、黃疸等臨床癥狀,嚴(yán)重者出現(xiàn)急性梗阻性化膿性膽管炎,危及生命,故膽管結(jié)石患者大多需要手術(shù)治療。自Phillip于1991年率先開展了腹腔鏡膽總管切開取石、T管引流術(shù)[3],該術(shù)式已逐漸被外科醫(yī)師和患者接受,但長期T管引流存在著膽汁大量流失、電解質(zhì)紊亂、延長患者恢復(fù)時(shí)間、增加患者痛苦等諸多問題,隨著微創(chuàng)技術(shù)的不斷發(fā)展及患者對治療的要求不斷提高,腹腔鏡下一期縫合術(shù)逐漸開始應(yīng)用于臨床,但一期縫合存在其嚴(yán)格的局限性,隨著內(nèi)鏡技術(shù)的日臻完善,全國數(shù)個(gè)醫(yī)療中心采用術(shù)中腹腔鏡、膽道鏡、十二指腸鏡聯(lián)合(以下簡稱三鏡聯(lián)合)解決肝外膽管結(jié)石,收到了很好的效果[1,6]。目前我國肝膽胰外科針對肝外膽管結(jié)石的腹腔鏡手術(shù)治療主要存在上述三種術(shù)式。評估比較這三種術(shù)式對肝外膽管結(jié)石的療效對比具有積極意義。目的：探討腹腔鏡膽總管探查一期縫合及術(shù)中腹腔鏡、膽道鏡、十二指腸鏡三鏡聯(lián)合的可行性及安全性,比較肝外膽管結(jié)石三種解決模式的優(yōu)劣材料及方法：采用回顧性分析方法收集自2013年1月至2015年4月于我院我科接受手術(shù)治療的77例肝外膽管結(jié)石患者,按其采取T管引流、膽管一期縫合、術(shù)中膽管一期縫合聯(lián)合留置鼻膽管分為3組(LCBDE-T組、LCBDE-PS組、LCBDE-ENBD組),分別比較術(shù)后住院天數(shù)、引流管留置時(shí)間、首次排氣時(shí)間、術(shù)后并發(fā)癥發(fā)生率,評價(jià)該兩種術(shù)式的臨床療效。結(jié)果：所有患者均采用手術(shù)治療,近期結(jié)果中,T管引流術(shù)組與一期縫合組(LCBDE-T組、LCBDE-PS組)在術(shù)后平均住院天數(shù)、首次排氣時(shí)間、引流管留置時(shí)間、膽瘺發(fā)生率等方面均存在統(tǒng)計(jì)學(xué)差異(P0.05)。一期縫合組與三鏡聯(lián)合組(LCBDE-PS組、LCBDE-ENBD組)在以上方面無統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論：1、一期縫合相較于T管引流可有效地縮短術(shù)后住院時(shí)間、術(shù)后排氣時(shí)間及引流管留置時(shí)間。2、三鏡聯(lián)合技術(shù)拓寬了一期縫合的適應(yīng)證,通過內(nèi)鏡技術(shù)的組合最大限度地實(shí)現(xiàn)了膽石癥的微創(chuàng)治療。3、肝外膽管結(jié)石的手術(shù)治療需遵循個(gè)體化治療的原則。
[Abstract]:Cholelithiasis is a common and frequently occurring disease in hepatobiliary and pancreatic surgery. The latest study shows that cholecystolithiasis accounted for 79.9%, extrahepatic cholelithiasis combined with cholecystolithiasis accounted for 9.2%, extrahepatic bile duct stones accounted for 6.2%. According to statistics, the incidence of gallstones in western countries is about 10% to 40%, and mainly gallstones, while in eastern countries, the incidence of gallstones is about 2% and 6%. In recent years, the incidence of cholelithiasis has gradually increased [1,2]. Most bile duct stones will appear fever, abdominal pain, jaundice and other clinical symptoms, severe cases of acute obstructive suppurative cholangitis, life-threatening, so most of the patients with bile duct stones need surgical treatment. Laparoscopic choledocholithotomy and T-tube drainage were first carried out by Phillip in 1991. This procedure has been accepted by surgeons and patients gradually, but there is a large amount of bile loss and electrolyte disorder in long-term T-tube drainage. With the continuous development of minimally invasive technology and the continuous improvement of patients' requirements for treatment, laparoscopic primary suture gradually began to be used in clinical practice, and many other problems, such as prolonging the recovery time and increasing the pain of patients, and so on. However, the first-stage suture has its strict limitations. With the improvement of endoscopic technology, several medical centers throughout the country have adopted intraoperative laparoscopy, choledochoscopy and duodenoscopy (hereinafter referred to as three-mirror combination) to solve extrahepatic bile duct stones. Received very good results [1, 6]. At present, there are three kinds of laparoscopic treatment of extrahepatic bile duct stones in hepatobiliary and pancreatic surgery of our country. It is significant to evaluate and compare the curative effects of these three methods for extrahepatic bile duct stones. Objective: to investigate the feasibility and safety of laparoscopic common bile duct exploration with primary suture, intraoperative laparoscopy, choledochoscopy and duodenoscopy. To compare the advantages and disadvantages of three methods for the treatment of extrahepatic bile duct stones: retrospective analysis was used to collect 77 patients with extrahepatic bile duct stones who underwent surgical treatment from January 2013 to April 2015 in our hospital, according to which T tube drainage was performed. The patients were divided into three groups (LCBDE-T group, LCBDE-PS group, LCBDE-ENBD group). The days of hospitalization, drainage tube indwelling time and first exhaust time were compared. The incidence of postoperative complications was evaluated and the clinical efficacy of the two methods was evaluated. Results: all patients were treated by operation. In the recent results, the average hospitalization days, the first exhaust time and the drainage tube indwelling time in the T tube drainage group and the primary suture group (LCBDE-T group, LCBDE-PS group) were compared with those in the T tube drainage group and the primary suture group (LCBDE-PS group). There were statistical differences in the incidence of biliary fistula (P0.05). There was no significant difference between the primary suture group and the LCBDE-PS group (LCBDE-ENBD group) in the above aspects (P0.05). Conclusion: 1, compared with T-tube drainage, primary suture can effectively shorten postoperative hospital stay, postoperative exhaust time and drainage tube indwelling time. 2. The combination of three-mirror technique broadens the indication of primary suture. The minimally invasive treatment of cholelithiasis can be achieved by the combination of endoscopic techniques. 3. The principle of individualized treatment should be followed in the surgical treatment of extrahepatic bile duct stones.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R657.42
本文編號(hào)：2440090
[Abstract]:Cholelithiasis is a common and frequently occurring disease in hepatobiliary and pancreatic surgery. The latest study shows that cholecystolithiasis accounted for 79.9%, extrahepatic cholelithiasis combined with cholecystolithiasis accounted for 9.2%, extrahepatic bile duct stones accounted for 6.2%. According to statistics, the incidence of gallstones in western countries is about 10% to 40%, and mainly gallstones, while in eastern countries, the incidence of gallstones is about 2% and 6%. In recent years, the incidence of cholelithiasis has gradually increased [1,2]. Most bile duct stones will appear fever, abdominal pain, jaundice and other clinical symptoms, severe cases of acute obstructive suppurative cholangitis, life-threatening, so most of the patients with bile duct stones need surgical treatment. Laparoscopic choledocholithotomy and T-tube drainage were first carried out by Phillip in 1991. This procedure has been accepted by surgeons and patients gradually, but there is a large amount of bile loss and electrolyte disorder in long-term T-tube drainage. With the continuous development of minimally invasive technology and the continuous improvement of patients' requirements for treatment, laparoscopic primary suture gradually began to be used in clinical practice, and many other problems, such as prolonging the recovery time and increasing the pain of patients, and so on. However, the first-stage suture has its strict limitations. With the improvement of endoscopic technology, several medical centers throughout the country have adopted intraoperative laparoscopy, choledochoscopy and duodenoscopy (hereinafter referred to as three-mirror combination) to solve extrahepatic bile duct stones. Received very good results [1, 6]. At present, there are three kinds of laparoscopic treatment of extrahepatic bile duct stones in hepatobiliary and pancreatic surgery of our country. It is significant to evaluate and compare the curative effects of these three methods for extrahepatic bile duct stones. Objective: to investigate the feasibility and safety of laparoscopic common bile duct exploration with primary suture, intraoperative laparoscopy, choledochoscopy and duodenoscopy. To compare the advantages and disadvantages of three methods for the treatment of extrahepatic bile duct stones: retrospective analysis was used to collect 77 patients with extrahepatic bile duct stones who underwent surgical treatment from January 2013 to April 2015 in our hospital, according to which T tube drainage was performed. The patients were divided into three groups (LCBDE-T group, LCBDE-PS group, LCBDE-ENBD group). The days of hospitalization, drainage tube indwelling time and first exhaust time were compared. The incidence of postoperative complications was evaluated and the clinical efficacy of the two methods was evaluated. Results: all patients were treated by operation. In the recent results, the average hospitalization days, the first exhaust time and the drainage tube indwelling time in the T tube drainage group and the primary suture group (LCBDE-T group, LCBDE-PS group) were compared with those in the T tube drainage group and the primary suture group (LCBDE-PS group). There were statistical differences in the incidence of biliary fistula (P0.05). There was no significant difference between the primary suture group and the LCBDE-PS group (LCBDE-ENBD group) in the above aspects (P0.05). Conclusion: 1, compared with T-tube drainage, primary suture can effectively shorten postoperative hospital stay, postoperative exhaust time and drainage tube indwelling time. 2. The combination of three-mirror technique broadens the indication of primary suture. The minimally invasive treatment of cholelithiasis can be achieved by the combination of endoscopic techniques. 3. The principle of individualized treatment should be followed in the surgical treatment of extrahepatic bile duct stones.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R657.42
【共引文獻(xiàn)】
相關(guān)期刊論文 前6條
1 古延麗;周曉鳳;;經(jīng)內(nèi)鏡逆行性胰膽管造影的護(hù)理體會(huì)[J];吉林醫(yī)學(xué);2012年23期
2 張魁;;護(hù)理干預(yù)降低ERCP及EST術(shù)后并發(fā)急性胰腺炎的臨床研究[J];家庭護(hù)士;2008年23期
3 于金華;;ERCP及EST的術(shù)中配合及護(hù)理[J];內(nèi)蒙古醫(yī)學(xué)院學(xué)報(bào);2010年S5期
4 楊梅展;;膽總管結(jié)石內(nèi)鏡治療的護(hù)理體會(huì)[J];臨床合理用藥雜志;2012年12期
5 屈莉莉;;膽總管結(jié)石患者行逆行胰膽管造影術(shù)的護(hù)理[J];實(shí)用醫(yī)藥雜志;2009年11期
6 李久芬;吳秋香;;護(hù)理干預(yù)對經(jīng)內(nèi)鏡逆行性胰膽管造影術(shù)后的影響[J];實(shí)用醫(yī)學(xué)雜志;2007年02期
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