CAJ | 학술논문

目的探讨经皮胆总管探查、内置管内引流手术治疗胆道多发结石的临床效果.方法回顾性分析2002年3月至2010年9月解放军第四五一医院收治的962例胆总管结石患者的临床资料.全组患者均行LC,采用自制器械行胆总管探查,将内置管放置在胆总管和十二指肠内以内引流胆汁,通过十二指肠注水的膨抽试验确认内置管放入十二指肠,术后30 d经十二指肠镜拔出内置管.结果全组患者中成功完成经皮胆总管探查、内置管内引流手术864例,中转开腹42例,中转腹腔镜胆总管T管外引流56例.864例患者手术时间为20～72 min,平均手术时间为(36±18)min;术后住院时间为(6.6±2.1)d;术后出现腹膜后腔脓肿经局部引流治疗痊愈2例,出现胆汁漏经保守治疗痊愈32例;术后30 d 862例患者通过B超检查随访,其中603例发现胆总管内置管影像,经十二指肠镜拔出内置管,1例内置管回缩胆总管经EST取出,258例内置管自然脱落.864例患者术后随访1～3年无胆管狭窄,26例胆总管复发结石经EST取出.结论经皮胆总管探查、内置管内引流手术是治疗胆道多发结石的一种安全而简便的微创方法.
목적 탐토경피담총관탐사、내치관내인류수술치료담도다발결석적림상효과.방법 회고성분석2002년3월지2010년9월해방군제사오일의원수치적962례담총관결석환자적림상자료.전조환자균행LC,채용자제기계행담총관탐사,장내치관방치재담총관화십이지장내이내인류담즙,통과십이지장주수적팽추시험학인내치관방입십이지장,술후30 d경십이지장경발출내치관.결과 전조환자중성공완성경피담총관탐사、내치관내인류수술864례,중전개복42례,중전복강경담총관T관외인류56례.864례환자수술시간위20～72 min,평균수술시간위(36±18)min;술후주원시간위(6.6±2.1)d;술후출현복막후강농종경국부인류치료전유2례,출현담즙루경보수치료전유32례;술후30 d 862례환자통과B초검사수방,기중603례발현담총관내치관영상,경십이지장경발출내치관,1례내치관회축담총관경EST취출,258례내치관자연탈락.864례환자술후수방1～3년무담관협착,26례담총관복발결석경EST취출.결론 경피담총관탐사、내치관내인류수술시치료담도다발결석적일충안전이간편적미창방법.
Objective To investigate the efficacy of laparoscopic percutaneous common bile duct exploration (LPCBDE) with internal draining tube placement for the treatment of cholelithiasis. Methods The clinical data of 962 patients with choledocholithiasis who were admitted to the No. 451 Hospital of PLA were retrospectively analyzed. A self-made internal draining tube was placed in the common bile duct and duodenum to drain bile internally. The correct position of the internal draining tube was comfirmed by injecting water into and draining water from duodenum. The internal draining tube was pulled out with the help of duodenoscope at 30 days after the operation. Results LPCBDE with internal draining tube placement was successfully performed on 864 patients. Forty-two patients were transferred to open surgery, and 56 patients were transferred to receive LPCBDE with T-tube drainage. The mean operation time was (36 ± 18) minutes (range, 20-72 minutes), and the length of postoperative hospital stay was (6.6 ±2.1)days. Two patients were complicated with retroperitoneal abscess and they were cured by puncture and drainage, 32 patients were complicated with bile leakage and they were cured by conservative treatment. A total of 862 patients were followed up by B ultrasound at 30 days after the operation. The internal draining tube which was confirmed in the common bile duct was extracted with duodenoscope in 603 patients; the internal draining tube which was drawn back in 1 patient was removed with endoscopic sphincterotomy ( EST); the internal draining tube was removed naturally in 258 patients. The follow-up period ranged from 1 to 3 years, 26 patients had recurrent cholelithiasis and they were treated by EST. Conclusions LPCBDE with internal draining tube placement is a safe and minimally invasive method for the treatment of cholelithiasis.