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胆囊结石伴急性胆源性胰腺炎的微创治疗VIP免费

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·临床论著·胆囊结石伴急性胆源性胰腺炎的微创治疗肖竣陈海川俞海波金小丹(浙江省温州市中心医院肝胆外科腹腔镜中心,温州325000)【摘要】目的探讨胆囊结石伴急性胆源性胰腺炎(acutebiliarypancreatitis,ABP)的微创治疗方法及手术时机。方法回顾分析我院2008年5月~2013年5月胆囊结石伴ABP122例的临床资料。先保守治疗,磁共振胰胆管成像(MRCP)明确胆总管有无结石梗阻,104例未发现结石者急性胰腺炎恢复后行腹腔镜胆囊切除术(laparoscopiccholecystectomy,LC)。18例MRCP发现胆总管下段结石,行内镜逆行胆胰管造影(ERCP)+十二指肠乳头括约肌切开(EST)取石+鼻胆管引流(ENBD)治疗成功,再行LC。结果轻型106例,手术时间为发病后7~14天;重型16例,手术时间为发病后15~30天。无中转开腹、胆管损伤及死亡。其中107例随访5~8个月,无胰腺炎复发。结论对胆囊结石伴ABP应常规MRCP检查。未发现胆总管结石者待胰腺炎恢复后行LC;有胆总管结石伴梗阻者72小时内用十二指肠镜取出胆管下端嵌顿结石并ENBD,待胰腺炎恢复后再行LC;无梗阻者保守治疗胰腺炎恢复后,先行ERCP并取石,再行LC。手术时机应遵循“个体化”原则,一般轻型胰腺炎可在发病1~2周内手术。采用上述方法治疗胆囊结石伴ABP安全、有效、微创、可行。【关键词】胆囊结石;急性胆源性胰腺炎;磁共振胰胆管成像;腹腔镜胆囊切除术;内镜逆行胆胰管造影术中图分类号:R657.4文献标识:A文章编号:1009-6604(2014)05-0399-03doi:10.3969/j.issn.1009-6604.2014.05.005Mini-invasiveTherapyforAcuteBiliaryPancreatitisAccompanyingGallstonesXiaoJun,ChenHaichuan,YuHaibo,etal.DepartmentofHepatobiliarySurgery,WenzhouCentralHospital,Wenzhou325000,China【Abstract】ObjectiveToexplorethemini-invasivetherapyandtheoperationopportunityforthetreatmentofgallstonewithacutebiliarypancreatitis(ABP).MethodsThedataof122casesofgallstonewithABPinourhospitalbetweenMay2008andMay2013wereretrospectivelyreviewed.Allpatientsunderwentconventionaltreatmentfirstandmagneticresonancecholangiopancreatography(MRCP)wasusedtoconfirmwhethertherewasstoneobstructioninthecommonbileduct.The104patientswithoutcholedocholithiasisunderwentlaparoscopiccholecystectomy(LC)aftertheirrecoveryfrompancreatitis.EighteenpatientsdiagnosedascholedocholithiasisbyMRCPreceivedendoscopictherapy(endoscopicretrogradecholangiopancreatography+endoscopicsphincterotomy+endoscopicnasobiliarydrainage)andthestoneswereremovedsuccessfully,thenLCwasperformed.ResultsThe106casesofmildacutepancreatitisunderwentLCwithin7-14daysfollowingtheattack.The16casesofsevereacutepancreatitisunderwentLCwithin15-30daysfollowingtheattack.Casesinthisgrouphadnoconversiontoopensurgery,bileductinjuryordeath.Amongthe122patients,107werefollowedupfor5-8months,andnoacutepancreatitisrecurrencewasfound.ConclusionsForpatientsofgallstonewithABP,MRCPisaroutinetestbeforethesurgery.Forpatientswithgallstonealone,LCshouldbeperformedaftertheirrecoveryfrompancreatitis.Thepatientswithcholedocholithiasisandbileductobstructionshouldreceiveemergencyendoscopictherapywithin72hours,andLCshouldbeperformedaftertheirrecoveryfrompancreatitis;thepatientswithcholedocholithiasisbutwithoutbileductobstructionshouldreceiveERCPfirstandthenLCaftertheirrecoveryfrompancreatitis.Theoperationopportunityshouldbeindividualized.MostofthepatientswithmildacutepancreatitisshouldundergoLCwithin1-2weeksoftheattack.Theabovetreatmentissafe,effectiveandminimallyinvasiveforpatientsofgallstonewithABP.【KeyWords】Gallstone;Acutebiliarypancreatitis;Magneticresonancecholangiopancreatography;Laparoscopiccholecystectomy;Endoscopicretro...

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胆囊结石伴急性胆源性胰腺炎的微创治疗

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