十二指肠镜及腹腔镜治疗肝外胆管结石手术时机探究.docVIP

十二指肠镜及腹腔镜治疗肝外胆管结石手术时机探究 　【摘要】 目的：探讨十二指肠镜与腹腔镜治疗肝外胆管结石的最佳手术时间间隔。方法：先行十二指肠镜逆行胰胆管造影+内镜下十二指肠乳头切开术治疗胆总管结石，研究组在72h内行腹腔镜胆囊切除术；对照组在72h后行腹腔镜胆囊切除术。对比治疗后两组胆囊标本壶腹区平均中性粒细胞数，腹腔镜胆囊切除术操作时间及并发症发生率等指标。结果：研究组胆囊标本壶腹区平均中性粒细胞数少于对照组，为（3.4±1.3） vs. （7.8±1.1）,（t=14.247，P=0.000），平均手术操作时间短于对照组，为（24.6±2.8)h vs. (37.8±3.1)h,(t=17.464，P=0.000），并发症发生率与对照组相比无显著性差异（3.2% vs. 3.3%,χ2=0.000，P=1.000）。结论：逆行胰胆管造影+十二指肠乳头切开取石术与腹腔镜胆囊切除术的最佳间隔时间是＜72h。 【关键词】 胆总管结石；内窥镜逆行胰胆管造影术；内窥镜括约肌切开术；胆囊切除术，腹腔镜 【Abstract】 Ｏbjective:To explore the best operation opportunity between endoscopic retrograde cholangiopancreatography(ERCP),endoscopic sphincterotomy(EST) and laparoscopic cholecystectomy(LC) in the management of calculus of extrahepatic bile duct.Methods:First common bile duct calculi (CBDC) cured by ERCP+EST.In research group,LC was followed ERCP+EST within 72 hours and LC was followed ERCP+EST after 72 hours in control group.Contrast to the average number of neutrophil gallbladder ampulla triangle,the average time of LC operation and the postoperative complication in two groups.Results:The average number of neutrophil was fewer(3.4±1.3) vs.(7.8±1.1),(t=14.247,P=0.000) and the average time of LC was shorter in research group (24.6±2.8) vs.(37.8±3.1),(t=17.464,P=0.000),the postoperative complication was no difference in two groups(3.2% vs. 3.3%,χ2=0.000,P=1.000).Conclusions:The best operation opportunity between ERCP+EST and LC in the management of calculus of extrahepatic bile duct is within 72 hours. 【Key words】 Common bile duct calculi;Endoscopic retrograde cholangiopancreatography;Endoscopic sphincterotomy;Cholecystectomy,laparoscopic 临床上15%～18%的胆囊结石患者合并有胆总管结石［1］。20世纪80年代末期，随着十二指肠镜技术的发展，十二指肠镜逆行胰胆管造影（endoscopic retrograde cholangiopancreatography,ERCP），内镜下十二指肠乳头切开术（endoscopic sphincterotomy,EST），腹腔镜胆囊切除术+胆总管探查术（laparoscopic cholecystectomy and laparoscopic common bile duct exploration,LCBDE）技术的成熟。胆总管结石常选择先行十二指肠乳头切开取石术（ERCP+EST），再行腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）。两次手术之间的间隔有不同的见解［2］。本研究通过临床对照两次手术不同时间间