肝外胆管结石三种手术治疗模式的临床疗效比较
发布时间：2019-03-14 15:03
【摘要】：胆管结石是肝胆胰外科的常见病及多发病,最新研究表明,胆囊结石发病占79.9%；肝外胆管结石合并胆囊结石发病占9.2%；肝外胆管结石占6.2%。据统计,在西方国家,胆结石的发病率约为10%-40%,且主要为胆囊结石；而在东方国家,其发病率约为2%-6%,近年来胆石症的发病率呈逐渐上升趋势[1、2]。大多数胆管结石都会出现发热、腹痛、黄疸等临床症状,严重者出现急性梗阻性化脓性胆管炎,危及生命,故胆管结石患者大多需要手术治疗。自Phillip于1991年率先开展了腹腔镜胆总管切开取石、T管引流术[3],该术式已逐渐被外科医师和患者接受,但长期T管引流存在着胆汁大量流失、电解质紊乱、延长患者恢复时间、增加患者痛苦等诸多问题,随着微创技术的不断发展及患者对治疗的要求不断提高,腹腔镜下一期缝合术逐渐开始应用于临床,但一期缝合存在其严格的局限性,随着内镜技术的日臻完善,全国数个医疗中心采用术中腹腔镜、胆道镜、十二指肠镜联合(以下简称三镜联合)解决肝外胆管结石,收到了很好的效果[1,6]。目前我国肝胆胰外科针对肝外胆管结石的腹腔镜手术治疗主要存在上述三种术式。评估比较这三种术式对肝外胆管结石的疗效对比具有积极意义。目的：探讨腹腔镜胆总管探查一期缝合及术中腹腔镜、胆道镜、十二指肠镜三镜联合的可行性及安全性,比较肝外胆管结石三种解决模式的优劣材料及方法：采用回顾性分析方法收集自2013年1月至2015年4月于我院我科接受手术治疗的77例肝外胆管结石患者,按其采取T管引流、胆管一期缝合、术中胆管一期缝合联合留置鼻胆管分为3组(LCBDE-T组、LCBDE-PS组、LCBDE-ENBD组),分别比较术后住院天数、引流管留置时间、首次排气时间、术后并发症发生率,评价该两种术式的临床疗效。结果：所有患者均采用手术治疗,近期结果中,T管引流术组与一期缝合组(LCBDE-T组、LCBDE-PS组)在术后平均住院天数、首次排气时间、引流管留置时间、胆瘘发生率等方面均存在统计学差异(P0.05)。一期缝合组与三镜联合组(LCBDE-PS组、LCBDE-ENBD组)在以上方面无统计学差异(P0.05)。结论：1、一期缝合相较于T管引流可有效地缩短术后住院时间、术后排气时间及引流管留置时间。2、三镜联合技术拓宽了一期缝合的适应证,通过内镜技术的组合最大限度地实现了胆石症的微创治疗。3、肝外胆管结石的手术治疗需遵循个体化治疗的原则。
[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.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.42
本文编号：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.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.42
【共引文献】
相关期刊论文 前6条
1 古延丽;周晓凤;;经内镜逆行性胰胆管造影的护理体会[J];吉林医学;2012年23期
2 张魁;;护理干预降低ERCP及EST术后并发急性胰腺炎的临床研究[J];家庭护士;2008年23期
3 于金华;;ERCP及EST的术中配合及护理[J];内蒙古医学院学报;2010年S5期
4 杨梅展;;胆总管结石内镜治疗的护理体会[J];临床合理用药杂志;2012年12期
5 屈莉莉;;胆总管结石患者行逆行胰胆管造影术的护理[J];实用医药杂志;2009年11期
6 李久芬;吴秋香;;护理干预对经内镜逆行性胰胆管造影术后的影响[J];实用医学杂志;2007年02期
，本文编号：2440090
本文链接：https://www.wllwen.com/yixuelunwen/waikelunwen/2440090.html
最近更新
教材专著
