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鼻胆囊引流管辅助下行腹腔镜胆囊次全切除术的临床体会
A clinical study of endoscopic naso-gallbladder drainage-assisted laparoscopic subtotal cholecystectomy
文章发布日期:2018年02月07日  来源:  作者:李广阔, 杨红,王洪波,等  点击次数:381次  下载次数:39次

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【摘要】:目的总结慢性萎缩性胆囊炎患者在鼻胆囊引流管(ENGBD)引导下施行腹腔镜胆囊次全切除术(LSC)的经验。方法收集2007年1月-2016年12月在武警重庆市总队医院肝胆外科、成都中医药大学附属医院普通外科和重庆市中医院普通外科收治的慢性萎缩性胆囊炎合并继发性胆总管结石患者124例,回顾分析其临床资料。所有病例均采用经内镜逆行胰胆管造影(ERCP)、括约肌切开后取石,术中置入ENGBD者分配入试验组(A组,n=47)、置入鼻胆引流管(ENBD)者分配入对照组(B组,n=77)。2组均于ERCP后施行腹腔镜胆囊切除术(LC)或腹腔镜胆囊次全切除术(LSC),困难病例则中转开腹实施胆囊切除术。计量资料2组间比较采用t检验;计数资料2组间比较采用χ2检验。结果A组在ENGBD的引导下,较B组更易完成LSC术(53.2% vs 20.8%),中转开腹实施胆囊切除术的比例也大为降低(4.3% vs 35.1%)。B组可能因胆囊与周围器官之间形成内瘘(包括Mirizzi综合征)、意外胆囊癌、胆囊管汇合异常等复杂情况,NEGBD难以成功置入,使得手术中发生肝动脉/肝静脉损伤,又因担心胆管损伤而被迫中转开腹。结论慢性萎缩性胆囊炎合并继发性胆总管结石时,于ERCP后置入ENGBD有助于LSC的顺利实施,可有效降低中转开腹比例。
【Abstract】:ObjectiveTo summarize our experience in endoscopic naso-gallbladder drainage (ENGBD)-assisted laparoscopic subtotal cholecystectomy (LSC) in patients with chronic atrophic cholecystitis. MethodsA retrospective analysis was performed for the clinical data of 124 patients with chronic atrophic cholecystitis complicated by secondary common bile duct stones who were admitted to Department of Hepatobiliary Surgery in Chongqing Hospital of Armed Police Force, Department of General Surgery in The Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, and Department of General Surgery in Chongqing Traditional Chinese Medicine Hospital from January 2007 to December 2016. All patients underwent endoscopic retrograde cholangiopancreatography (ERCP), sphincterotomy, and lithotomy. The patients undergoing ENGBD were enrolled as experimental group (group A with 47 patients), and those undergoing endoscopic nasobiliary drainage (ENBD) were enrolled as control group (group B with 77 patients). All patients were treated with laparoscopic cholecystectomy (LC) or LSC after ERCP, and the patients in difficult conditions were converted to open cholecystectomy (OC). The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. ResultsCompared with group B, group A had a significantly higher success rate of LSC (53.2% vs 20.8%) and a significantly lower proportion of patients undergoing OC (4.3% vs 35.1%). Due to the complicated conditions such as internal fistula between the gallbladder and adjacent organs (including Mirizzi syndrome), unsuspected gallbladder carcinoma, and cystic duct abnormalities, group B had a great difficulty in the placement of ENGBD, which led to injuries in the hepatic artery/vein, and some patients were converted to open surgery due to concerns of bile duct injury. ConclusionIn patients with chronic atrophic cholecystitis with secondary choledocholithiasis, ENGBD after ERCP helps with the successful performance of LSC and can effectively reduce the proportion of conversion to laparotomy.
【关键字】:胆囊炎; 腹腔镜, 胆囊切除术; 引流术
【Key words】:cholecystitis; cholecystectomy, laparoscopic; drainage
【引证本文】:LI GK, YANG H, WANG HB, et al. A clinical study of endoscopic naso-gallbladder drainage-assisted laparoscopic subtotal cholecystectomy[J]. J Clin Hepatol, 2018, 34(3): 521-525. (in Chinese)
李广阔, 杨红, 王洪波, 等. 鼻胆囊引流管辅助下行腹腔镜胆囊次全切除术的临床体会[J]. 临床肝胆病杂志, 2018, 34(3): 521-525.

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