概要
目 的
通过探讨胃镜联合胆道镜在腹腔镜胆总管探查术 (LCBDE) 中的应用, 为胆总管结石的手术治疗提供更多的手术方式, 改善患者生活质量, 降低手术难度。
创新点
摒弃了以往 LCBDE 术后需行 T 管引流的方式, 以鼻胆管代替 T 管, 改善患者生活质量。 同时胃镜的操作难度较内镜逆行胰胆管造影 (ERCP) 低。 因此, 本手术方式可以得到更好的推广。
方 法
研究对象为 2017 年 7 月 1 日至 2017 年 10 月 30 日于浙江大学医学院附属邵逸夫医院就诊的胆总管结石患者。 收集这些患者的年龄、 性别等临床数据, 排除那些不能耐受麻醉、 患急性胰腺炎及急性胆管炎、 并发肝内胆管结石及胆总管结石呈泥沙状或者絮状的患者。 对患者行胃镜联合胆道镜的 LCBDE 手术, 统计其手术时长、 术中出血量、 术后并发症、 术后住院时长以及住院花费。
结 论
胃镜联合胆道镜放置鼻胆管在预防 LCBDE 术后胆漏上切实有效, 且由于术后无需留置 T 管, 对患者的生活质量有所改善。 同时, 本手术方式对手术操作技术的要求较低, 对于初学胆总管一期缝合的医师来说, 可降低其术后胆漏的概率。
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Song-mei LOU, Zheng-rong WU, Gui-xing JIANG, Hua SHEN, Yi DAI, Yue-long LIANG, Li-ping CAO, and Guoping DING performed the surgery. Min ZHANG performed data analysis and edited the manuscript. Song-mei LOU and Guo-ping DING contributed to study design, writing and editing of the manuscript. All authors have read and approved the final manuscript and, therefore, have full access to all the data in the study and take responsibility for the integrity and security of the data.
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Song-mei LOU, Min ZHANG, Zheng-rong WU, Guixing JIANG, Hua SHEN, Yi DAI, Yue-long LIANG, Li-ping CAO, and Guo-ping DING declare that they have no conflict of interest.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study.
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Project supported by the Foundation Project for Medical Science and Technology of Zhejiang Province (Nos. 2019ZH022 and 2018KY478) and the Zhejiang Province Public Welfare Technology Application Research Project (No. LGF19H180021), China
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Lou, Sm., Zhang, M., Wu, Zr. et al. Combined gastroscopic and choledochoscopic transabdominal nasobiliary drainage. J. Zhejiang Univ. Sci. B 20, 940–944 (2019). https://doi.org/10.1631/jzus.B1900060
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DOI: https://doi.org/10.1631/jzus.B1900060