【摘要】 目的探讨腹腔镜、胆管镜、扩张导管(逐级扩张导管、球囊导管)、T管支架捆绑引流(LCDTS)治疗胆囊结石、胆总管结石及十二指肠乳头部梗阻或狭窄的应用体会。方法回顾性分析1999年11月至2017年9月期间,符合入选标准的52例患者的临床资料。结果腹腔镜下行胆囊切除术和胆总管探查取石术52例。逐级导管扩张乳头并留置T形管+塑料胆管支架75.1%(39/52),逐级导管联合球囊导管扩张乳头并留置T形管+塑料胆管支架11.5%(6/52),因逐级导管扩张乳头不成功而中转为腹腔镜术中内镜乳头切开术并留置T形管+塑料胆管支架9.6%(5/52),因塑料胆管支架放置失败而中转为T管引流术3.8%(2/52)。术后残石1例(1.9%),胆汁漏1例(1.9%),经T管瘘道拔支架失败2例(3.8%)。无肠穿孔、胆管穿孔、大出血、急性胰腺炎等并发症,无死亡患者。术后总并发症发生率为7.7%(4/52)。结论从本研究初步研究发现,只要病例选择合适,LCDTS治疗胆囊结石、胆总管结石及十二指肠乳头部梗阻或狭窄是可行、有效和安全的。更多还原

【Abstract】 Objective To explore the surgical technique and clinical effect of laparoscopy, choledochoscopy, dilatable catheter, T tube and plastic biliary stent bundling drainage(LCDTS) for the treatment of extrahepatic bile duct stones with obstruction of papillory. Methods The clinical data of 52 cases of extrahepatic bile duct stones with obstruction of papillory undergoing LCDTS were analyzed retrospectively from November 1999 to September 2017 in the Second People’s Hospital of Chengdu.Results 52 cases were preformed laparoscopic cholecystectomy and exploration of common bile duct. The duodenal papilla was expanded step by step with dilatable catheter, T tube and plastic biliary stent drainage was indwelled in 39 cases(39/52); The duodenal papilla was expanded step by step with dilatable catheter and balloon catheter, and T tube and plastic biliary stent drainage was indwelled in 6 cases(6/52); duodenoscopic papillary sphincterotomy and indwelling T tube and plastic biliary stent drainage was performed due to failure of step by step expanding. in 5 cases(5/52); T shape tube drainage was performed due to failure of placing the plastic biliary stent drainage in 2 cases(2/52). Residual stone was found in 1 case(1/59), bile leakage was found in 1 case(1/59), 2 cases(3.8%) were unsuccessful to pull out the stent through the T tube fistula. No cases was found with perforation of intestine and bile duct, bleeding, acute pancreatitis. No death cases was found. The total postoperative complication rate was 7.7%(4/52).Conclusion From preliminary results of limited cases in this study from our hospital, if patients are suitable, LCDTS for treatment of the extrahepatic bile duct stones with obstruction of papillory is safe and effective.更多还原