【作者】 刘海斌；

【导师】 赵吉生； 房学东；

【作者基本信息】 吉林大学 ， 外科学， 2006， 硕士

【摘要】 目的:探讨EST治疗胆总管结石的实用性及其与传统开腹术式相比所具有的优点。方法:回顾性分析了我院2003年5月至2005年8月期间139例胆总管结石的治疗方法和结果。其中56例行内镜下十二指肠乳头括约肌切开取石术,74例行胆总管切开取石T型管引流术,10例行胆肠吻合术。结果:EST取石组治愈率和术后结石残留发生率明显低于胆总管切开取石T型管引流组(P<0.05),术后并发症发生率两组无显著性差异(P>0.05)。EST取石组中12例由于EST切开不充分、切开后胆汁流出不畅或怀疑结石残留而留置了ERBD管。2例伴有位置较高的胆总管狭窄,EST无法解除狭窄,在取石成功后留置了ERBD管。2例在EST取石失败后留置了ERBD管。EST+LC组中1例先行LC治疗后,因EST取石治疗失败而行开腹手术治疗,1例EST后LC操作失败转行开腹胆囊切除术。结论:EST治疗胆总管结石是安全有效的治疗方法,与胆总管切开取石T管引流术相比具有创伤小、结石残留率低等优点,胆总管结石合并胆囊结石的患者应先行EST取石,胆囊结石不影响胆总管结石的微创治疗,ERBD是EST治疗胆总管结石的一个较好的补充和完善,对部分EST治疗失败的胆总管结石需行传统开腹手术或LCHTD进行治疗。更多还原

【Abstract】 Objective: To explore the merit of EST compared withorthodox modus operandi and the clinical practicality of EST for thetherapy of choledocholith.Methods: Some of the patients were treated by EST.Afterendoscopic retrograde pancreatocholangiography, cut the duodenalpapilla according to the size of stone and the length of stenosis andthen take out stone directly or after be crashed. If the cut length isnot enough, or stone can not be taken out, or bile can not run-outeasily and smoothly, or suspect residual stone, or EST can not relievethe common bile duct stricture and open operation is not suit for thepatient, endoscopic retrograde biliary drainage tube will be set in thebile duct after EST. some patient with pecholecystolithiasis andcholedocholith may excise gallbladder through laparoscope before orafter EST. The others of the patients were treated by open Operation.Open operation include Cholecystectomy and T-tube, and Theend-to-side Cholangiojejunostomy(Roux-en-Y).modus operandi wasdetermined by the condition of calculus obstruction and biliarytract. The investigation retrospecttively analysesed the managementof 139 cases of choledocholith. SPSS11.0 systems software was usedto analysis Clinical data. Patients divided into groups according todifferent index. The comparison of interclass rate apply X2 test.P<0.05 is considered to be statistical significance.Results: 47 cases were treated by EST. Cure rate of patientswith EST was 83.9%.From which 14 cases made use of endoscopicretrograde biliary drainage tube. Two cases was set endoscopicretrograde biliary drainage tube after failure of EST. from which onecase appeared to be calculus fragmentation.67 cases were treated byCholecystectomy and T-tube. Cure rate of which was 90.5%.Fivecases took a turn for the better and found residual stone after T-tubevisualization. Rate of success and residual stone of patients with ESTis obviously lower than those with Cholecystectomy and T-tube(P<0.05).10 cases were treated by Cholangiojejunostomy. cure rateof which was 100%. There are ten patients with choledocholith andcholecystolithiasis treated by EST and LC. From which one caseapplied open operation after LC because of failure of EST. one caseconverted to open operation after EST because of failure of LC. Theothers were treated by LC after EST.Analysis: The retrospective analysis demonstrate that Rate ofresidual stone of patients with EST is obviously lower than thosewith Cholecystectomy and T-tube(P<0.05), and Rate of success ofpatients with EST was 83.9%.So EST is the optimal management aslong as if only EST is fit for patient’s condition. At the present,Orthodox modus operandi used to treat choledocholith with strictureof common bile duct include oddisphincterotomy and the end-to-sidecholangiojejunostomy(Roux-en-Y). Now oddisphincterotomy hasbeen raplaced gradually by EST. But if obstruction can not be treatedpartly, patients should be treated by the end-to-side cholangiojejuno-stomy. Besides ERBD tube can be used to Support the stricture ofcommon bile duct and is good to drainage bile and prevent residualstone. So patients can be well treated by EST and ERBD, that cannot be treated by end-to-side Cholangiojejunostomy. patients withcholedocholith should insist on microinvasive therapy regardless ofcholecystolithiasis, because that can retain the integrity of bilecommen duct and avoid choledochotomy and prevent fromconverting to open operation after LC for the failure of EST.Conclusion: EST is a safe and effective and Microinvasivetherapy of patients with choledocholith. Rate of residual stone ofpatients with EST is obviously lower than those withCholecystectomy and T-tube(P<0.05).Patients with choledocholithshould insist on Microinvasive therapy regardless ofcholecystolithiasis. ERBD is a supplement to EST. But some patientsstill should be treated by open operation or LCHTD after failure ofEST.更多还原