CAJ | 학술논문

目的探讨螺旋CT三维胆道成像联合内镜下逆行胆胰管造影(ERCP)、内镜Oddi括约肌切开取石术(EST)与腹腔镜胆囊切除术(LC)对胆囊结石合并胆总管结石的治疗作用.方法回顾性分析2007年7月至2009年6月期间,应用螺旋CT三维胆道成像联合十二指肠镜及腹腔镜治疗胆囊结石合并胆总管结石患者30例的方法与经验.并与2005年7月至2007年6月期间,传统开腹胆囊切除、胆总管切开取石、T管引流术治疗胆囊结石合并胆总管结石36例患者进行对比,比较两组患者术后恢复情况.结果两镜联合组全部病例取得成功,ERCP并发症2例,均为急性轻型胰腺炎,螺旋CT三维胆道成像胆总管、肝总管、左右肝管显影率为100%,胆囊管显影率为73%,可清晰显示胆囊管的走行及汇入胆总管的位置.术后下床活动时间、胃肠功能恢复时间、进食时间、术后住院时间均优于传统手术组(P＜0.05).结论螺旋CT三维胆道成像联合十二指肠镜与腹腔镜治疗胆囊结石合并胆总管结石具有安全、创伤小、术后恢复快,且能减少术中胆管损伤的优点,具有较好的应用价值.
목적 탐토라선CT삼유담도성상연합내경하역행담이관조영(ERCP)、내경Oddi괄약기절개취석술(EST)여복강경담낭절제술(LC)대담낭결석합병담총관결석적치료작용.방법 회고성분석2007년7월지2009년6월기간,응용라선CT삼유담도성상연합십이지장경급복강경치료담낭결석합병담총관결석환자30례적방법여경험.병여2005년7월지2007년6월기간,전통개복담낭절제、담총관절개취석、T관인류술치료담낭결석합병담총관결석36례환자진행대비,비교량조환자술후회복정황.결과 량경연합조전부병례취득성공,ERCP병발증2례,균위급성경형이선염,라선CT삼유담도성상담총관、간총관、좌우간관현영솔위100%,담낭관현영솔위73%,가청석현시담낭관적주행급회입담총관적위치.술후하상활동시간、위장공능회복시간、진식시간、술후주원시간균우우전통수술조(P＜0.05).결론 라선CT삼유담도성상연합십이지장경여복강경치료담낭결석합병담총관결석구유안전、창상소、술후회복쾌,차능감소술중담관손상적우점,구유교호적응용개치.
Objective To summarize the curative effect of three-dimensional spiral CT cholangiography combined with endoscopic retrograde cholangiopancreatography(ERCP),endoscopic sphincterotomy(EST)and laparoscopic cholecystectomy(LC)for treatment of patients with cholelithiasts concurrent with choledocholithiasis.Methods A retrospective analysis was carried out for 30 cases of cholelithiasts concurrent with choledocholithiasis which were treated with ERCP and three-dimensional spiral CT cholangiography before laparoscopic cholecystectomy from July 2007 to June 2009.And the post operation parameters were compared with those of 36 patients who received traditional operation from July 2005 to June 2007.Results All the procedures were successfully accomplished.Complication occurred in 2 cases.both with mild acute pancreatitis.With the three-dimensional spiral CT cholangiography,the intra-hepatic bile ducts,the hepatic bile duct and the common bile duct were visible in 100 percent patients,and choleeyst bile duct was visible in 73%patients,and three-dimensional spiral CT cholangiography can tell the position of cholecyst duct,then can decrease the possibility of damage of bile duct.The gastrointestinal function recovery time and feeding time after operation,the in hospital time after operation in the ERCP and three-dimensional spiral CT cholangiography before laparoscopic cholecystectomy group were superior to those of the traditional operation patients(P＜0.05).Conclusion ERCP and three-dimensional spiral CT cholangiography before laparoscopic cholecystectomy for treatment of patients with cholelithiasts concurrent with choledocholithiasis is safe,with less trauma and fast recover after operation and Can decrease the possibility of damaging bile duct,which can be used widely.