腹腔镜胰管切开取石+胰管T管引流术在慢性胰腺炎合并胰管结石中的应用价值

Application value of laparoscopic pancreatic duct lithotomy and pancreatic duct T drainage for chronic pancreatitis complicated with pancreatic duct stones

摘要:

目的 探讨腹腔镜胰管切开取石+胰管T管引流术在慢性胰腺炎合并胰管结石中的应用价值。方法 回顾性分析2017年1月－2020年6月浙江大学医学院附属金华医院5例行腹腔镜胰管切开取石+胰管T管引流术治疗胰管结石的患者的临床资料。结果 5例患者均顺利完成手术。其中，1例Ⅳ_b型胰管结石予以EMS碎石清石系统碎石。手术时间120～180 min，平均145 min；术中出血量15～50 mL，平均29 mL；术后胃肠道功能恢复时间1.0～2.0 d，平均1.6 d；术后住院时间4.0～11.0 d，平均7.0 d；T管拔除时间32.0～60.0 d，平均42.4 d。术后无胰瘘、出血和腹腔感染等并发症发生。5例患者疗效均为优良。术后随访27.0～55.0个月，平均40.8个月。1例糖尿病患者胰岛素用量较术前减少；1例T管造影示胰管残余结石，行胆道镜检查术取出残余结石。患者均未见结石复发，无恶变。结论 腹腔镜胰管切开取石+胰管T管引流术创伤小，恢复快，疗效满意，操作简单，是一种安全有效的术式。

Abstract:

Objective To investigate the application value of laparoscopic pancreatic duct lithotomy and pancreatic duct T drainage in treatment of chronic pancreatitis complicated with pancreatic duct stones.Methods Clinical data of patients underwent laparoscopic pancreatic duct lithotomy and pancreatic duct T drainage for pancreatic duct stones from January 2017 to June 2020 were retrospectively analyzed.Results All the 5 cases were successfully operated. Among of them, one case of Ⅳ_b type pancreatic duct stone was treated with EMS lithotripsy system. The operative time was 120 ~ 180 min, with an average of 145 min; The intraoperative bleeding was 15 ~ 50 mL, with an average of 29 mL; The postoperative gastrointestinal function recovery time was 1.0 ~ 2.0 d, with an average of 1.6 d; The postoperative hospital stay was 4.0 ~ 11.0 d, with an average of 7.0 d; The T tube removal time was 32.0 ~ 60.0 d, with an average of 42.4 d. No postoperative complications such as pancreatic leakage, bleeding and abdominal infection occurred. The follow-up time was 27.0 ~ 55.0 months, with an average of 40.8 months. The insulin dosage of 1 diabetic patient was reduced compared with that before surgery. One patient showed residual pancreatic duct stones by T tube angiography, and the residual stones were removed by choledochoscopy. There was no recurrence of calculi and no malignant change.Conclusion Laparoscopic pancreatic duct lithotomy and pancreatic duct T drainage is a safe and effective operation with little trauma, quick recovery, satisfactory curative effect and simple operation.