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胆总管造口术

胆总管造口术的相关文献在1996年到2022年内共计61篇,主要集中在外科学、肿瘤学、内科学 等领域,其中期刊论文61篇、专利文献100690篇;相关期刊35种,包括中国临床保健杂志、医学临床研究、临床肝胆病杂志等; 胆总管造口术的相关文献由204位作者贡献,包括吴金术、严晓梅、刘亚辉等。

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胆总管造口术—发文趋势图

胆总管造口术

-研究学者

  • 吴金术
  • 严晓梅
  • 刘亚辉
  • 刘凯
  • 孙敏
  • 杨树成
  • 熊军
  • 蔡茂怀
  • 许丁伟
  • 高红玉
  • 期刊论文
  • 专利文献

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    • 张家泉; 李旺勇; 孙杰; 冯其柱; 王琦
    • 摘要: 目的研究独一味联合地佐辛镇痛对老年胆总管结石病人术后的影响。方法选取淮南市第一人民医院2017年6月至2020年5月收治的年龄≥60岁的102例胆总管结石的病人,随机数字表法分为两组,对照组51例,术后给予0.25%地佐辛、阿扎司琼0.08 mg/mL行自控镇痛,负荷量2 mL,以2 mL/h为背景剂量持续泵入,单次剂量2 mL,锁定时间20 min。研究组51例,在对照组基础上口服独一味胶囊,3粒/次,3次/天,连服7 d。比较两组术后1 d、2 d、3 d数字分级法疼痛(NRS)评分,术后72 h静脉补救镇痛次数,镇痛泵(PCA泵)泵压次数,呕吐、头晕、切口出血发生率,病人镇痛效果满意度,血清皮质醇、醛固酮及C反应蛋白(CRP)含量。结果通过独立样本t检验和χ2检验分析,研究组术后1 d[(3.92±0.90)分比(5.49±4.68)分]、2 d[(3.37±1.13)分比(4.01±1.30)分]、3 d[(3.09±1.20)分比(3.98±1.60)分]NRS疼痛评分均低于对照组,差异有统计学意义(P<0.05);研究组手术后72 h静脉补救镇痛次数为4次低于对照组的11次,研究组PCA泵压次数为12次低于对照组的20次,研究组病人镇痛效果满意度评分[(4.37±0.77)分比(3.10±0.72)分]明显高于对照组,均差异有统计学意义(P<0.05);研究组术后1 d血清皮质醇[(417.65±13.56)nmol/L比(464.98±19.01)nmol/L]、醛固酮[(0.22±0.01)µg/L比(0.27±0.01)µg/L]及CRP含量[(102.20±11.83)mg/L比(104.26±12.67)mg/L]明显低于对照组,差异有统计学意义(P<0.05)。结论开腹胆总管切开取石术后的老年病人使用独一味联合地佐辛镇痛疗效确切,能增加病人满意度,改善术后应激及炎症反应,有临床应用的价值。
    • 金明均; 董亮; 杨宏; 董迎; 包国强; 崔华雷
    • 摘要: 目的 探讨腹腔镜下手术在儿童先天性胆总管扩张(congenital choledochus dilatation,CCD)中的应用效果及安全性.方法 选择50例行腹腔镜手术治疗的CCD患儿作为观察组,同时选取同期行开腹手术治疗的50例CCD患儿作为对照组,两组均行扩张胆管囊肿切除+肝总管空肠Roux-Y吻合术治疗.比较两组手术相关情况,手术前后检测两组肝功能指标以及炎症指标.结果 观察组手术时间长于对照组,术中出血量低于对照组,术后排便时间、术后进食时间、术后住院时间短于对照组,差异均有统计学意义(P<().05).从术前1 d到术后7 d的血清总胆红素(total bilirubin,TBIL)、丙氨酸转氨酶(alanine aminotransferase,ALT)、天冬氨酸转氨酶(aspartate transaminase,AST)、C 反应蛋白(C-reactive protein,CRP)和白细胞介素6(interleukin-6,IL-6)水平,观察组和对照组差异有统计学意义.观察组并发症发生率低于对照组,差异有统计学意义(X2=5.316,P<0.05).两组平均手术及住院费用比较,差异无统计学意义(t=1.518,P>0.05).结论 腹腔镜下扩张胆总管囊肿切除+肝总管空肠Roux-Y吻合术治疗儿童CCD相对于开腹手术能有效减轻手术创伤性应激与炎症反应,术后恢复快,并发症少.
    • 付建柱; 计嘉军; 于则利
    • 摘要: 目的 探讨再次手术治疗胆肠吻合口狭窄同时行空肠肠襻固定的治疗效果及意义.方法 回顾性分析2016年1月~2020年1月治疗的15例胆肠吻合口狭窄患者,全部病例均切除原吻合口重新行胆肠Roux-en-Y吻合,同时行空肠肠襻固定.肠襻固定方式分为两种,一种为胆肠吻合口近端预留10~15 cm的盲襻,并与剑突下腹壁标记固定,一种在胆肠吻合口远端10 cm左右空肠侧壁与右侧腹壁标记固定.同时经固定肠管壁中央在肠道内留置T管.结果 共行盲襻固定5例,侧壁固定10例,3例发生术后并发症,其中胆瘘1例,切口感染1例,腹腔出血1例,经保守治疗后治愈,无围手术期死亡.术后随访1例发生吻合口狭窄,局麻下空肠穿刺窦道扩张,经胆道镜治疗后治愈.结论 吻合口狭窄再手术时,应该考虑到术后再次狭窄的可能,术中可以固定并标记空肠肠襻.再发狭窄时可以经固定肠襻穿刺扩张行胆道镜治疗,避免再次开腹手术.
    • 胡磊; 侯亚峰; 叶显道; 李仁宝
    • 摘要: 目的 探索腹腔镜联合胆管镜在老年人胆总管结石的应用.方法 从2014年2月至2016年12月,通过超声、上腹部CT或MRI等影像学检查收集56例老年胆总管结石患者,分别进行腔镜胆总管探查(LCDE)和开腹胆总管探查(OCDE),通过查看麻醉记录单、住院清单及医嘱单获得患者的住院费用、饮食时间、术后住院时间,同时术后观察患者并发症发生情况并进行分析.结果 LCDE组的手术时间较OCDE组稍长[(115±25)min比(148±32)min,t=4.223,P0.05).LCDE组因手术操作困难发生中转2例(2/29),胆漏1例(1/27),术后残留结石1例(1/27),重症肺炎1例(1/27),无切口感染;OCDE组发生切口感染1例(1/27),无胆漏、重症肺炎及残留结石,两组并发症发生率差异无统计学意义(P>0.05).结论 老年人胆总管结石通过腹腔镜联合胆管镜治疗是安全的,值得推广,但应进行充分的围手术期处理,才能有效防止相关并发症的发生.
    • 胡博; 成广海; 詹建兴; 申海军; 李海民
    • 摘要: 目的 探讨腹腔镜下胆总管囊肿切除后肝管十二指肠吻合术(A组)、肝管空肠Roux-en-Y吻合术(B组)和改良胆肠袢式吻合术(C组)等三种胆道重建术治疗的临床效果和安全性.方法 回顾性分析2012年1月至2016年12月间腹腔镜手术治疗先天性胆总管囊肿的46例临床资料,A组15例、B组17例和C组14例.采用SPSS19.0软件包对数据进行统计描述和分析.术中术后围手术期指标等采用(x-±s)描述,组间比较采用单因素方差分析.近期并发症等分类资料采用频数(构成比)描述,组间比较采用Pearsonχ2检验.P0.05).结论 腹腔镜下改良胆肠袢式吻合术与肝管十二指肠吻合术、肝管空肠Roux-en-Y吻合术比较,手术疗效均较理想,同时手术时间更短、术后恢复快、住院时间短等优势,值得临床应用和推广.
    • 纪福龙
    • 摘要: Objective To investigate the clinical effect of holistic resection of cysts for children with huge choledochal cyst.Methods 29 children with huge choledochal cyst treated at our hospital from January,2010 to May,2015 were chosen for research;all were treated with reconstruction of the extrahepatic biliary system,total resection of common bile duct cyst,and Roux-en-Y choledochojejunostomy.The clinical effect and short-and long-term complications were observed.Results The operation was completed successfully in all the 29 cases.The intra-operative examination found that all children had no pancreatic duct stones and no stenosis in bilateral bile duct opening.However,14 cases (44.83%) complicated with cholangiopancreatoconfluence.The intra-operative bleeding volume was 26.73-101.82 ml,with an average of(53.87±10.54) ml.All the children were cured and discharged from the hospital after the operation.3 cases (10.34%) got postoperative complications,including 2 cases of bile leakage and 1 cases of wound infection;after symptomatic treatment,all of them were improved and no serious complications such as intestinal obstruction occurred.The postoperative follow-up time was 9 months-2 years,with an average of (14.15±3.28) months.All the children had normal liver and gallbladder function,and no malnutrition,pancreatic disease,bile duct stones,and reflux cholangitis occurred.Conclusion Holistic resection of cysts for children with huge choledochal cyst has good treatment effects and good short-and long-term safety.%目的 探讨囊肿整体切除术治疗小儿先天性巨大胆总管囊肿的临床效果.方法 选取本院2010年1月至2015年5月收治的29例先天性巨大胆总管囊肿患儿进行研究,均采用胆总管囊肿全切除术与肝总管空肠Roux-en-Y吻合术治疗,观察治疗效果及术后近远期并发症发生情况.结果 29例患儿均顺利完成手术,术中检查发现所有患儿无胰管结石,双侧胆管开口无狭窄发生,但其中14例(44.83%)合并胰胆合流异常.本组患儿术中出血量26.73 ~ 101.82 ml,平均出血量为(53.87±10.54) ml,术后所有患儿均好转并出院.术后共发生3例(10.34%)并发症,包括2例胆漏,1例伤口感染,经对症治疗后均好转,无肠梗阻等严重并发症发生.术后随访9个月~2年,平均(14.15 ± 3.28)个月,所有患儿肝胆功能正常,无营养不良、胰腺病变、胆管结石及反流性胆管炎等并发症发生.结论 囊肿整体切除术治疗小儿先天性巨大胆总管囊肿效果较好,近远期安全性良好.
    • 徐玉; 张小弟; 王智翔
    • 摘要: 盲端综合征是胆总管十二指肠侧侧吻合术后少见的并发症,罕见于自发胆囊-胆管-消化道内瘘后和胆总管空肠端-侧吻合术后.在微创外科技术发展以前,传统外科手术曾是其主要的治疗手段.回顾了近年来盲端综合征的研究进展,认为经内镜逆行胰胆管造影是确诊该病的主要方法,经内镜乳头括约肌切开术联合胆道清理是盲端综合征最简单、有效的治疗措施.同时还通过对大量相关文献的研究,并结合临床实际情况,对盲端综合征作出了简要综述,以期提高对盲端综合征的重视.%Sump syndrome is a rare complication of side-to-side choledochoduodenostomy (CDD) and occasionally occurs after spontaneous gallbladder-bile duct-digestive tract fistula or end-to-side choledochojejunostomy.Before the development of minimally invasive surgery,conventional surgical operation used to be the most important treatment method.This article reviews the research advances in sump syndrome in recent years and points out that endoscopic retrograde cholangiopancreatography is the major diagnostic method for this disease,and endoscopic sphincterotomy combined with bile duct debridement is the most simple and effective measure for the treatment of sump syndrome.Meanwhile,this article briefly reviews sump syndrome with reference to related literature and clinical practice,in order to raise the awareness for sump syndrome.
    • 余杰雄; 邝乃乐; 伍隽华
    • 摘要: Objective To explore the clinical value of rigid nephroscopy and flexible cholangioscopy in laparoscopic common bile duct exploration in the treatment of choledocholithiasis. Methods A retrospective analysis of forty seven cases of choledocholithiasis undergoing laparoscopic common bile duct exploration in our hospital from January 2014 to January 2016 was carried out. All the cases were diagnosed with choledocholithiasis by CT and ultrasonography before operations. According to the different endoscopic surgeries, they were divided into flexible cholangioscopy group (23 cases, directly inserting the flexible cholangioscopy into common bile duct) and rigid nephroscopy group (24 cases, firstly inserting the external sheath sized 18-20 into common bile duct, and then putting the rigid nephroscopy from the external sheath). The operation time, operative bleeding, postoperative bleeding, bile leakage, and rates of residual stones was compared between the two groups. Results The difference of operation time between two groups was of statistical significance [(124.2 ± 20.4) min vs (152.8 ± 29.0) min, t=3.924, P<0.05]. The differences of surgical completion rate (100.0%vs 87.0%,c2=3.344,P=0.067), operative bleeding [(28.70 ± 8.69) ml vs (26.67 ± 8.17) ml, t=0.825,P=0.414)], rate of postoperative bleeding (4.2%vs 0, c2=0.979, P=0.322), bile leakage (8.3%vs 13.0%, c2=0.274, P=0.601), and rate of residual stones (0 vs 8.7%, c2=2.180, P=0.140) between two groups was of no statistical significance. Conclusion For patients with simple choledocholithiasis, it can reduce the operation time using rigid nephroscopy and sheath, and has obvious advantages compared with flexible cholangioscopy in the laparoscopic common bile duct exploration.%目的:探讨经皮肾镜(硬镜)和纤维胆道镜(软镜)联合腹腔镜处理胆总管结石的应用价值。方法回顾性分析本院2014年1月至2016年1月间接受腹腔镜胆总管切开取石术的47例患者临床资料。所有患者术前均行CT及彩超检查确诊为胆总管结石,按照术中使用的内镜不同分成软镜组(23例,直接置入纤维胆道镜)和硬镜组(24例,置入18~20号外鞘,再于鞘内置入经皮肾镜),统计分析两组患者在手术时间、术中出血量、术后出血、胆漏、结石残留等情况的差异。结果硬镜组均顺利完成手术,而软镜组则有3例术中需协同使用硬镜来取出结石,结石取出率差异无统计学意义(100.0%vs 87.0%,c2=3.344,P=0.067)。硬镜组和软镜组的手术时间差异有统计学意义[(124.2±20.4)min vs(152.8±29.0)min,t=-3.924,P<0.05],术中出血量[(28.70±8.69)ml vs (26.67±8.17)ml,t=-0.825,P=0.414)]、术后出血(4.2%vs 0,c2=0.979,P=0.322)、术后胆漏(8.3%vs 13.0%,c2=0.274,P=0.601)及结石残留率(0 vs 8.7%,c2=2.180,P=0.140)差异均无统计学意义。结论对于单纯胆总管结石患者,硬镜及鞘管在腹腔镜胆总管切开取石术中的应用可极大地减少取石、碎石时间,缩短手术时间,较软镜优势明显。
    • 吴龙; 开喆; 史华明
    • 摘要: 目的 探讨高位胆管空肠Roux-Y吻合术吻合口瘘的防治措施.方法 回顾因不同疾病行高位胆管空肠Roux-Y吻合术16例,其中发生吻合口瘘6例,分析出现瘘的原因及防治措施.结果 16例患者均获出院,6例吻合口瘘患者中,1例经再次开腹手术治愈,1例经多次腹腔穿刺置管引流痊愈,另4例经引流管持续引流后治愈.结论 通过术中改进缝合技术和材料并注意细节处理、术后持续引流或穿刺置管等微创方式,可有效预防和治疗高位胆管空肠Roux-Y吻合术后的吻合口瘘.
    • 黄洁; 龙奎; 许丁伟; 孙敏
    • 摘要: 目的 比较完全腹腔镜肝总管-空肠吻合术与开腹手术的临床疗效.方法 回顾性分析37例接受腹腔镜肝总管空肠Roux-en-Y吻合术及同期42例接受传统开放肝总管空肠Roux-en-Y吻合术.比较2组患者手术时间、术中出血量、切口长度、术后住院时间、术后胃肠功能恢复时间、切口感染率以及术后胆瘘发生率.结果 观察组患者手术时间为(275.43±12.28) min,高于对照组的(189.12±19.35) min(P =0.031);观察组患者术中出血量为(83.13±6.34) ml,切口长度(5.76±0.7)cm,术后胃肠道恢复时间为(43.33±3.15)h,术后住院时间为(12.65±2.19)d,均低于对照组的(180.37±9.67) ml,(18.51±1.9)cm,(70.45±4.97)h,(22.16±4.61) d(P <0.05).观察组中术后切口感染发生率为5.4%,低于对照组(19.07%)(x2=22.12,P<0.05).两组术后胆瘘发生率无显著性差异.结论 完全腹腔镜肝总管-空肠吻合术安全有效,创伤较小,术后并发症少,适合临床推广应用.%Objective To compare the feasibility and safety of laparoscopic Roux-en-Y choledochojejunostomy versus open Roux-en-Y choledochojejunostomy.Methods From October 2011 to June 2013,37 patients underwent laparoscopic Roux-en-Y choledochojejunostomy (observation group) and 42 underwent open Roux-en-Y choledochojejunostomy (control group).We retrospectively compare the two groups in terms of operation time,intraoperative blood loss,length of incision,postoperative hospital stay,postoperative gastrointestinal function recovery time,incision infection rate and the incidence of biliary fistula after surgery.Results In observation group operation time was (275.43 t 12.28) min,higher than that of control group (189.12 ± 19.35) min (P =0.031),intraoperative blood loss was (83.13 ±6.34) ml,incision length (5.76 ±0.7) cm,postoperative recovery time of gastrointestinal tract of (43.33 ±3.15) h,postoperative hospital stay (12.65 ± 2.19) d,were in favor of the observation group which were respectively (180.37 ±9.67) ml,(18.51 ±1.9) cm,(70.45 ±4.97) h and (22.16 ±4.61) d (t =33.17,36.73,33.17,P < 0.05).Postoperative incision infection rate in observation group was 5.4%,lower than the control group (19.07%) (chi-square =22.12,P < 0.05).Between the two groups there was no significant difference in the incidence of biliary fistula.Conclusions Laparoscopic Roux-en-Y hepatojejunostomy is safe,effective,and less traumatic procedure.
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