腹腔镜胆总管探查诊治急性胆源性胰腺炎46例临床分析

目的 探讨腹腔镜胆总管探查诊治急性胆源性胰腺炎(ABP)的安全性和有效性.方法 对2007年7月-2011年12月我院收治的46例ABP经保守治疗后,早期行经腹腔镜胆囊切除、胆总管探查术.术中利用CB30L胆道镜探查、静脉注射胰高血糖素后加压冲洗及经胆囊管胆总管汇合部切开取石等方法 进行诊断性探查及胆总管结石的清除.结果 ①46例均经手术治疗后痊愈,术后发热5例、胆漏2例均经对症治疗后痊愈;②术前超声、MRCP检查灵敏度为35.7%(10/28)、95.2%(20/21);③单纯胆囊结石与胆囊结石合并胆总管结石患者术前部分生化指标及胆总管直径比较差异无统计学意义(P＞0.05).结论 腹部超声、MRCP检查由于各自的局限性常漏诊胆总管下段的小结石,及早经腹腔镜行胆囊切除术、胆总管探查术治疗ABP安全有效,术中选择适宜的胆道探查、结石清除方法 可简化手术操作并提高安全性.

Laparoscopic Common Bile Duct Exploration in Treating Acute Biliary Pancreatitis

Objective To explore the safety and effectiveness of laparoscopic common bile duct exploration（LCBDE） in treating acute biliary pancreatitis.Methods 46 patients with biliary pancreatitis during July 2007 and December 2011 were treated with early laparoscopic cholecystectomy and exploration of common bile duct after initial conservative therapy.Methods such as CB30L choledochoscope,douching under pressure after intravenous injection with glucagon and removing stones at the assembled position of cystic duct and common bile duct were used for diagnostic exploration and stone cleaning.Results ①46 patients were all cured after operation,5 patients with fevers and 2 with bile leaks which were cured by symptomatic treatment.②The positive coincidence rate of preoperative ultrasound and MRCP was 35.7%（10/28） and 95.2%（20/21） respectively.③There was no statistical significance in the differences of preoperative biochemical indexes and diameters of CBD between patients with simple gallstone and coexisting with CBD stones（P〉0.05）.Conclusion The small stones of lower CBD are often missed by transabdominal ultrasonography and MRCP for their limitations.Early laparoscopic cholecystectomy and LCBDE for acute biliary pancreatitis is safe and effective.Using the proper methods of biliary tract exploration and stone retraction may facilitate the procedure intraoperative.