腹腔镜Ⅰ期联合ERCP治疗高龄胆囊胆管结石的临床研究
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摘要
目的比较高龄胆囊胆管结石给予腹腔镜术中Ⅰ期联合经内镜逆行胰胆管造影(ERCP)与经ERCP取石+择期腹腔镜胆囊切除术(LC),分析腹腔镜术中Ⅰ期联合ERCP对高龄胆囊胆管结石患者的疗效。方法选择2006年9月至2017年4月对96例高龄胆囊结石合并胆总管结石的患者分别采用经ERCP取石+择期腹腔镜胆囊切除术及腹腔镜术中I期联合ERCP,比较患者手术操作时间、结石的取石成功率、并发症、住院时间,调查患者舒适度及住院相关费用等指标。结果 ERCP+择期LC组手术均成功,ERCP用时18～60 min,LC用时25～75 min,平均(62.56±6.32)min;其中3例因LC术后胆囊结石经胆囊颈管再次掉入胆总管而再次行ERCP治疗。ERCP手术后共发生4例高淀粉酶血症、轻度胰腺炎1例,所有患者均经过生长抑素治疗并给予禁食水等症状缓解,无大出血和穿孔等严重并发症,总住院时间10～15 d,平均(12.56±3.02)d。腹腔镜术中联合ERCP取石组患者均手术成功。ERCP用时15～65 min。LC用时20～68 min,平均(54.52±4.33)min;手术后出现5例高淀粉酶血症,轻型胰腺炎1例,患者治疗后基本恢复正常,且无出血和穿孔等情况发生,总住院时间7～10 d,平均(8.45±2.23)d。2组患者手术时间、舒适度、住院时间及治疗费用比较,差异有统计学意义(P<0.05)。腹腔镜术中联合ERCP取石组患者术后生存质量及手术耐受性均优于ERCP+择期LC组,差异有统计学意义(P<0.05)。结论腹腔镜术中Ⅰ期联合ERCP在高龄胆囊胆管结石患者治疗中,提高患者的舒适度,缩短了住院时间,降低了手术费用,同时不会增加并发症的出现,为临床治疗提供了积极的理论基础,有助于临床实践应用。
Objective To compare the therapeutic effects of laparoscopic stage I combined with ERCP and ERCP stone removal + elective laparoscopic cholecystectomy(LC) on gallbladder bile duct stone.Methods A total of 96 elderly patients with gallbladder bile duct stone who were treated from September 2006 to April 2007 were enrolled in the study,who were treated by laparoscopic stage I combined with ERCP and ERCP stone removal + elective LC,respectively.The operation time,the success rate of stone removal,the incidence of complications,hospitalization time,patient's comfort degree,hospital-related expenses were observed and statistically analyzed.Results The surgeries by ERCP+ elective LC group were successful,ERCP time was 18～60 min,LC time was 25～75 min,with average time being(62.56±6.32)min,in whom, 3 cases were treated by ERCP again because of the stones being dropped into the gallbladder via gallbladder neck after LC. There were 4 cases of hyperamylasemia and mild pancreatitis after ERCP.All the patients were treated by somatostatin and fasting diet and water.No severe complications including major bleeding and perforation were found.Moreover the total hospital stay was 10～15 days,with average time being(12.56±3.02)days.The surgeries for the patients who were treated by laparoscopic surgery combined with ERCP were successful.ERCP took 15 to 65 minutes.LC used 20～68 min,with average time being(54.52±4.33)min,there were 5 cases of hyperamylasemia,1 case of mild pancreatitis after surgery,and no bleeding and perforation were found.The total hospitalization time was 7～10 days,with average time being(8.45±2.23)days.There were significant differences in the operation time,comfort degree,hospitalization time and treatment cost between the two groups(P<0.05).In addition the life quality of patients and surgical tolerance in laparoscopic surgery combined with ERCP were superior to those of ERCP+ elective LC group(P<0.05).Conclusion Phase I combined with ERCP in laparoscopic surgery in treatment of gallbladder bile duct stones in elderly patients can improve patient's comfort degree,shortens hospital stay,reduces surgical costs,without increasing the incidence of complications,therefor, it is worth using widely in clinical practice.
Objective To compare the therapeutic effects of laparoscopic stage I combined with ERCP and ERCP stone removal + elective laparoscopic cholecystectomy(LC) on gallbladder bile duct stone.Methods A total of 96 elderly patients with gallbladder bile duct stone who were treated from September 2006 to April 2007 were enrolled in the study,who were treated by laparoscopic stage I combined with ERCP and ERCP stone removal + elective LC,respectively.The operation time,the success rate of stone removal,the incidence of complications,hospitalization time,patient's comfort degree,hospital-related expenses were observed and statistically analyzed.Results The surgeries by ERCP+ elective LC group were successful,ERCP time was 18～60 min,LC time was 25～75 min,with average time being(62.56±6.32)min,in whom, 3 cases were treated by ERCP again because of the stones being dropped into the gallbladder via gallbladder neck after LC. There were 4 cases of hyperamylasemia and mild pancreatitis after ERCP.All the patients were treated by somatostatin and fasting diet and water.No severe complications including major bleeding and perforation were found.Moreover the total hospital stay was 10～15 days,with average time being(12.56±3.02)days.The surgeries for the patients who were treated by laparoscopic surgery combined with ERCP were successful.ERCP took 15 to 65 minutes.LC used 20～68 min,with average time being(54.52±4.33)min,there were 5 cases of hyperamylasemia,1 case of mild pancreatitis after surgery,and no bleeding and perforation were found.The total hospitalization time was 7～10 days,with average time being(8.45±2.23)days.There were significant differences in the operation time,comfort degree,hospitalization time and treatment cost between the two groups(P<0.05).In addition the life quality of patients and surgical tolerance in laparoscopic surgery combined with ERCP were superior to those of ERCP+ elective LC group(P<0.05).Conclusion Phase I combined with ERCP in laparoscopic surgery in treatment of gallbladder bile duct stones in elderly patients can improve patient's comfort degree,shortens hospital stay,reduces surgical costs,without increasing the incidence of complications,therefor, it is worth using widely in clinical practice.
引文
1 王明俊,钟文贵,祁玉波,等.腹腔镜联合十二指肠镜治疗胆囊结石合并胆总管结石,腹腔镜外科杂志,2010,15:203-206.
2 Gupta K,Perez-Miranda M,Kahaleh M,et al.Endoscopic ultrasound- assisted bile duct access and drainage:Multicenter,long-term analysis of approach,outcomes,and complications of a technique in evolution.Journal of clinical gastroenterology,2014,48:80-87.
3 吴君正,许晓飞,刘浩,等.双镜联合同期治疗胆囊结石并肝外胆管结石的临床对照研究.中国医科大学学报,2014,43:75-77.
4 Cawich SO,Arthurs M,Murphy T,et al.Complications of ERCP for choledocholithiasis in a sickle cell cohort.Tropical doctor,2015,45:15-20.
5 Granata A,Azzopardi N,Barresi L,et al.Biliary tree under a starry sky following an abdominal gun shot wound.Dig Liver Dis,2013,45:961.
6 王明俊,钟文贵,祁玉波,等.腹腔镜联合十二指肠镜治疗胆囊结石合并胆总管结石.腹腔镜外科杂志,2010,15:203-206.
7 吴胜,陈金锁,唐晓明,等.腹腔镜及选择性辅助小切口治疗胆囊结石合并肝外胆管结石的临床研究.重庆医学,2015,44:1807-1808,1811.
8 Brugge WR.Endoscopic approach to the diagnosis and treatment of pancreatic disease.Current opinion in gastroenterology,2013,29:559-565.
9 Tammaro S,Caruso R,Pallone F,et al.Post-endoscopic retrograde cholangio-pancreatography pancreatitis:is time for a new preventive approach?World J Gastroenterol,2012,18:4635-4638.
10 陈永标,池小斌,江艺,等.腹腔镜肝切除联合胆道镜治疗肝内外胆管结石36例.中国微创外科杂志,2016,16:777-779.
11 Joban G,Yldrm E,Gktürk S,et al.Body mass index,cholecystitis,cholelithiasis,pancreatitis and imaging of common bile duct stones.The American Journal of the Medical Sciences,2014,347:364-369.
12 刘志刚,刘丹峰,陈圣林,等.改良腹腔镜联合胆道镜手术治疗肝外胆道系统结石疗效观察.山东医药,2016,56:61-63.
13 Garewal D,Vele L,Waikar P,et al.Anaesthetic considerations for endoscopic retrograde cholangio- pancreatography procedures.Current opinion in anaesthesiology,2013,26:475-480.
14 许兆龙,龚兵,田兴梦,等.内镜逆行胰胆管造影术取石失败后即行腹腔镜胆总管探查术的临床观察.中国内镜杂志,2016,22:98-100.
15 徐琳,陈雪嘉,李敏,等.三镜同期手术治疗肝外胆管结石合并十二指肠乳头狭窄286例疗效观察及护理.重庆医学,2015,44:4888-4889.
16 管辉球,张俊华,徐恩文,等.输尿管导管胆道引流在腹腔镜胆囊切除术后内镜治疗非扩张性肝外胆管结石112例中的应用.中华消化杂志,2015,35:697-699.
17 Kwon YH,Cho CM,Jung MK,et al.Risk factors of open converted cholecystectomy for cholelithiasis after endoscopic removal of choledocholithiasis.Dig Dis Sci,2015,60:550-556.
18 吴君正,许晓飞,刘浩,等.双镜联合同期治疗胆囊结石并肝外胆管结石的临床对照研究.中国医科大学学报,2014,43:75-77.
19 段仁全,王伟,张慧慧,等.腹腔镜胆道再手术治疗60岁以上肝外胆管结石患者的效果观察.临床肝胆病杂志,2017,33:289-292.
2 Gupta K,Perez-Miranda M,Kahaleh M,et al.Endoscopic ultrasound- assisted bile duct access and drainage:Multicenter,long-term analysis of approach,outcomes,and complications of a technique in evolution.Journal of clinical gastroenterology,2014,48:80-87.
3 吴君正,许晓飞,刘浩,等.双镜联合同期治疗胆囊结石并肝外胆管结石的临床对照研究.中国医科大学学报,2014,43:75-77.
4 Cawich SO,Arthurs M,Murphy T,et al.Complications of ERCP for choledocholithiasis in a sickle cell cohort.Tropical doctor,2015,45:15-20.
5 Granata A,Azzopardi N,Barresi L,et al.Biliary tree under a starry sky following an abdominal gun shot wound.Dig Liver Dis,2013,45:961.
6 王明俊,钟文贵,祁玉波,等.腹腔镜联合十二指肠镜治疗胆囊结石合并胆总管结石.腹腔镜外科杂志,2010,15:203-206.
7 吴胜,陈金锁,唐晓明,等.腹腔镜及选择性辅助小切口治疗胆囊结石合并肝外胆管结石的临床研究.重庆医学,2015,44:1807-1808,1811.
8 Brugge WR.Endoscopic approach to the diagnosis and treatment of pancreatic disease.Current opinion in gastroenterology,2013,29:559-565.
9 Tammaro S,Caruso R,Pallone F,et al.Post-endoscopic retrograde cholangio-pancreatography pancreatitis:is time for a new preventive approach?World J Gastroenterol,2012,18:4635-4638.
10 陈永标,池小斌,江艺,等.腹腔镜肝切除联合胆道镜治疗肝内外胆管结石36例.中国微创外科杂志,2016,16:777-779.
11 Joban G,Yldrm E,Gktürk S,et al.Body mass index,cholecystitis,cholelithiasis,pancreatitis and imaging of common bile duct stones.The American Journal of the Medical Sciences,2014,347:364-369.
12 刘志刚,刘丹峰,陈圣林,等.改良腹腔镜联合胆道镜手术治疗肝外胆道系统结石疗效观察.山东医药,2016,56:61-63.
13 Garewal D,Vele L,Waikar P,et al.Anaesthetic considerations for endoscopic retrograde cholangio- pancreatography procedures.Current opinion in anaesthesiology,2013,26:475-480.
14 许兆龙,龚兵,田兴梦,等.内镜逆行胰胆管造影术取石失败后即行腹腔镜胆总管探查术的临床观察.中国内镜杂志,2016,22:98-100.
15 徐琳,陈雪嘉,李敏,等.三镜同期手术治疗肝外胆管结石合并十二指肠乳头狭窄286例疗效观察及护理.重庆医学,2015,44:4888-4889.
16 管辉球,张俊华,徐恩文,等.输尿管导管胆道引流在腹腔镜胆囊切除术后内镜治疗非扩张性肝外胆管结石112例中的应用.中华消化杂志,2015,35:697-699.
17 Kwon YH,Cho CM,Jung MK,et al.Risk factors of open converted cholecystectomy for cholelithiasis after endoscopic removal of choledocholithiasis.Dig Dis Sci,2015,60:550-556.
18 吴君正,许晓飞,刘浩,等.双镜联合同期治疗胆囊结石并肝外胆管结石的临床对照研究.中国医科大学学报,2014,43:75-77.
19 段仁全,王伟,张慧慧,等.腹腔镜胆道再手术治疗60岁以上肝外胆管结石患者的效果观察.临床肝胆病杂志,2017,33:289-292.