腹腔镜联合术中胆管造影、括约肌切开术序贯诊治胆结石病5年经验总结

Laparoscopic cholecystectomy combined with intraoperative cholanggiography and endoscopic sphincterotomy for the treatment of cholecystocholedocholithiasis.

目的 探讨腹腔镜胆囊切除术 (LaparoscopicCholecystectomy ,LC )联合术中胆管造影 (Intra operativeCholangiography,IOC)、胰胆镜括约肌切开术 (IntraoperativeEndoscopicSphincterotomy,IOEST)诊治胆囊结石合并胆总管结石疾病的价值。 方法 回顾分析LC联合IOC、IOEST诊断和治疗 10 6例胆囊结石合并胆总管结石患者的临床效果。 结果 6 0 4 % (6 4 / 10 6 )术前诊断胆囊结石 ,经IOC发现伴有胆总管结石 ;LC联合IOC、IOEST治疗胆囊结石合并胆总管结石手术成功率为 93 4 % (99/ 10 6 ) ,取净结石率99 0 % (98/ 99)。术后并发轻度急性胰腺炎 6例 (6 1% )、十二指肠穿孔 1例 (0 0 1% )、胆漏 1例(0 0 1% )、气胸 1例、漏诊十二指肠乳头癌 1例 (0 0 1% )、胃潴留 2例 (0 0 2 % )。术后平均住院时间 3 7天。 结论 IOC能有效避免漏诊LC中胆总管结石 ;LC联合IOC和IOEST能一次性有效微创治疗胆囊结石合并胆总管结石。

Objective To evaluate the effects of Laparoscopic cholecystectomy (LC) combined with intraoperative cholanggiography (IOC)and intraoperative endoscopic sphincterotomy (IOEST) for the treatment of cholecystocholedocolithiasis. Methods 106 cases with cholecystocholedocolithiasis diagnosed and treated by LC combined with IOC and IOEST were reviewed retrospectively. Results 60 40%(64/106)patients diagnosed cholelithiasis pre-LC were found choledocholithisis; LC combined with IOC and IOEST was successfully performed on 99 of 106 cases(93 40%),and their CBD stones were completely cleared in 98 of 99 cases(99 00%). Six cases(6 1%) were complicated with mild acute pancreatitis, 1 case(0 01%) with duodenal perforation,1 case(0 01%) with bile leakage, and 2 cases(0 02%) with stomach stasis. Conclusions LC combined with IOC and IOEST was a safe ,effective approach to diagnosis and minimally invasive treatment of cholecystocholedocholithiasis.