中国普通外科杂志2025，Vol.34Issue(2)：318-326,9.DOI:10.7659/j.issn.1005-6947.240608
新型经腹腔入路引导十二指肠乳头切开治疗结石性胆管炎合并Vater壶腹部狭窄的临床研究
Clinical study of a novel transabdominal approach guiding sphincterotomy for choledocholithiasis complicated by stenosis of the ampulla of Vater
摘要
Abstract
Background and Aims:Complex choledocholithiasis often coexists with stenosis of the ampulla of Vater,which increases the difficulty and complexity of treatment.If only the stones in the bile duct are removed without addressing the ampullary stenosis,the disease is prone to recurrence.Previously,most treatments involved the use of endoscopic retrograde cholangiopancreatography(ERCP)to guide the wire for sphincterotomy and stone extraction,followed by laparoscopic cholecystectomy.However,ERCP has limitations in handling complex cases.In response,our team pioneered a new method of treating choledocholithiasis combined with stenosis of the ampulla of Vater via a transabdominal approach.This study was performed to investigate the feasibility and efficacy of this method,aiming to provide a new therapeutic option for clinical practice. Methods:A randomized controlled study was conducted with 120 patients treated at Chengdu Second People's Hospital from 2021 to 2023 for gallbladder stones and choledocholithiasis with stenosis of the ampulla of Vater.Patients were divided into an observation group and a control group,with 60 cases in each group.The observation group underwent laparoscopic cholecystectomy with choledochotomy for stone extraction,followed by retrograde guidance of duodenal papillary sphincterotomy through the opened bile duct,simultaneously treating gallbladder,bile duct stones,and stenosis of the ampulla of Vater.The control group underwent traditional ERCP approach for sphincterotomy,stone extraction,and laparoscopic cholecystectomy.Perioperative variables were collected for both groups and the surgical outcomes were compared. Results:Among the 120 patients,54 were male and 66 were female.There were no statistically significant differences between the two groups in terms of stone extraction success rate,intraoperative blood loss,postoperative 24-h total bilirubin,direct bilirubin,transaminases,white blood cell count,jaundice relief time,or incidence rates of bile leakage,retroperitoneal bleeding/infection,and severe pancreatitis(all P>0.05).The observation group had significantly shorter average operative time and postoperative hospital stay compared to the control group(98.67 min vs.110.8 min,P<0.05;3.81 d vs.5.61 d,P<0.05).Additionally,the observation group had a significantly lower incidence of postoperative hyperamylasemia and/or hyperlipasemia and mild pancreatitis(1.67%vs.25.00%,P<0.001;0 vs.10%,P=0.027). Conclusion:The novel transabdominal approach is superior to the ERCP approach in terms of reducing surgery time and hospitalization time,and it carries a lower risk of postoperative mild pancreatitis and hyperamylasemia and/or hyperlipasemia.The stone extraction success rate is comparable to that of ERCP,making it a viable alternative treatment option.关键词
胆总管结石病/胆囊结石病/肝胰管壶腹/缩窄,病理性/腹腔镜/胰胆管造影术,内窥镜逆行Key words
Choledocholithiasis/Cholecystolithiasis/Ampulla of Vater/Constriction,Pathologic/Laparoscopes/Cholangiopan-creatography,Endoscopic Retrograde分类
医药卫生引用本文复制引用
周华波,何伊嘉,黎欢,吴洁,李广阔,孙科,刘进衡,陈安平..新型经腹腔入路引导十二指肠乳头切开治疗结石性胆管炎合并Vater壶腹部狭窄的临床研究[J].中国普通外科杂志,2025,34(2):318-326,9.基金项目
四川省成都市医学科研基金资助项目(2023293). （2023293）
