中华普通外科学文献（电子版）
中華普通外科學文獻（電子版）
중화보통외과학문헌（전자판）
Chinese Archives of General Surgery(Electronic Edition)
2015年
5期
373-377
,共5页
残留结石%十二指肠乳头球囊扩张%介入操作%取石%胆道镜
殘留結石%十二指腸乳頭毬囊擴張%介入操作%取石%膽道鏡
잔류결석%십이지장유두구낭확장%개입조작%취석%담도경
Residual stone%Papillary balloon dilation%Interventional procedures%Stone extrac-tion%Choledochoscope
目的 比较经T管球囊导管扩张乳头括约肌并推出结石技术与胆道镜取石的临床效果. 方法 选择2008年2月至2014年6月收治的41例手术后留置T管的胆总管残石患者,20例采用十二指肠乳头扩张推石治疗(乳头扩张组),21例进行胆道镜窦道取石治疗(胆道镜组). 比较两组患者术前胆总管直径﹑留置T管时间﹑胆道结石情况﹑手术操作时间﹑术中结石彻底清除率以及术后近期并发症发生率﹑结石复发率﹑胆道狭窄发生率等.结果 术前乳头扩张组患者T管放置时间为(24.2±9.7) d,明显短于胆道镜组的(65.4±14.6) d (t=16.422,P<0.01);乳头扩张组的T管直径(5.3±0.7) mm﹑胆总管直径(13±5) mm均较胆道镜组的(7.2±0.9) mm﹑(19±7) mm明显缩小,差异均有统计学意义(t=7.152,P<0.01;t=3.144,P<0.01).两组患者取石成功率﹑近远期并发症总发生率﹑手术早期的白细胞数量﹑C反应蛋白水平(CRP)﹑胆道结石复发率﹑并发症发生率差异无统计学意义.结论 经T管球囊导管扩张乳头括约肌清除胆总管结石具有与胆道镜窦道取石类似的效果,较后者明显缩短T管放置时间,对于较细的胆总管及T管患者仍然适用.
目的 比較經T管毬囊導管擴張乳頭括約肌併推齣結石技術與膽道鏡取石的臨床效果. 方法 選擇2008年2月至2014年6月收治的41例手術後留置T管的膽總管殘石患者,20例採用十二指腸乳頭擴張推石治療(乳頭擴張組),21例進行膽道鏡竇道取石治療(膽道鏡組). 比較兩組患者術前膽總管直徑﹑留置T管時間﹑膽道結石情況﹑手術操作時間﹑術中結石徹底清除率以及術後近期併髮癥髮生率﹑結石複髮率﹑膽道狹窄髮生率等.結果 術前乳頭擴張組患者T管放置時間為(24.2±9.7) d,明顯短于膽道鏡組的(65.4±14.6) d (t=16.422,P<0.01);乳頭擴張組的T管直徑(5.3±0.7) mm﹑膽總管直徑(13±5) mm均較膽道鏡組的(7.2±0.9) mm﹑(19±7) mm明顯縮小,差異均有統計學意義(t=7.152,P<0.01;t=3.144,P<0.01).兩組患者取石成功率﹑近遠期併髮癥總髮生率﹑手術早期的白細胞數量﹑C反應蛋白水平(CRP)﹑膽道結石複髮率﹑併髮癥髮生率差異無統計學意義.結論 經T管毬囊導管擴張乳頭括約肌清除膽總管結石具有與膽道鏡竇道取石類似的效果,較後者明顯縮短T管放置時間,對于較細的膽總管及T管患者仍然適用.
목적 비교경T관구낭도관확장유두괄약기병추출결석기술여담도경취석적림상효과. 방법 선택2008년2월지2014년6월수치적41례수술후류치T관적담총관잔석환자,20례채용십이지장유두확장추석치료(유두확장조),21례진행담도경두도취석치료(담도경조). 비교량조환자술전담총관직경﹑류치T관시간﹑담도결석정황﹑수술조작시간﹑술중결석철저청제솔이급술후근기병발증발생솔﹑결석복발솔﹑담도협착발생솔등.결과 술전유두확장조환자T관방치시간위(24.2±9.7) d,명현단우담도경조적(65.4±14.6) d (t=16.422,P<0.01);유두확장조적T관직경(5.3±0.7) mm﹑담총관직경(13±5) mm균교담도경조적(7.2±0.9) mm﹑(19±7) mm명현축소,차이균유통계학의의(t=7.152,P<0.01;t=3.144,P<0.01).량조환자취석성공솔﹑근원기병발증총발생솔﹑수술조기적백세포수량﹑C반응단백수평(CRP)﹑담도결석복발솔﹑병발증발생솔차이무통계학의의.결론 경T관구낭도관확장유두괄약기청제담총관결석구유여담도경두도취석유사적효과,교후자명현축단T관방치시간,대우교세적담총관급T관환자잉연괄용.
Objective To compare dilated papillary sphincter via T-tube balloon catheter to ex-trude stones and calculus removal with choledochoscope. Methods Forty-one patients with residual common bile duct stones after common bile duct exploration with T-tube drainage were enrolled in the study from February 2008 to June 2014. Twenty patients were treated with balloon dilation of the papilla and the use of an occlusion balloon for clearance of bile duct calculi via T tube, and were allocated to balloon sphincteroplasty group. The other 21 patients, treated with choledochoscope through T tube sinus, were allocated to choledochoscope group. The size of common bile duct, retention time of T tube, the size and number of stones, operation time, clearance rate of bile duct stones, and postoperative complications between the two groups were compared. Results The preoperative T tube indwelling time in balloon sphincteroplasty group was significantly shorter than that in choledochoscope group [(24.2±9.7) d vs (65.4± 14.6) d, t=16.4, P<0.01]. The size of common bile duct and the diameter of T tube in balloon sphinctero-plasty group were significantly shorter than those in choledochoscope group [(13±5) mm vs (19±7) mm, t=3.144, P<0.01; (5.3±0.7) mm vs (7.2±0.9) mm, t=7.152, P<0.01]. There was no significant difference be-tween the two groups in terms of clearance rate of bile duct calculi, overall postoperative morbidity rate, postoperative WBC count, C-reactive protein concentration, stone recurrence rate and bile duct stricture rate throughout the follow-up period after complete clearance of bile duct. Conclusions Common bile duct stone clearance by dilation of the papilla and evacuation of the residual stones with an occlusion bal-loon via T tube is as safe and effective as stone extraction with choledochoscope through T tube sinus. The technique can shorten T tube retention time and is still available to slim common bile duct and T tube.
