胆囊合并胆道结石的微创治疗

The minimally invasive surgery of cholecystolithiasis with bile duct stones existing

目的总结联合运用腹腔镜、十二指肠镜、胆道镜微创治疗胆囊合并胆道结石的经验。方法从1996年1月至2004年1月,运用三镜联合的手术方式,术前十二指肠镜逆行胆胰管造影检查(ERCP),十二指肠镜oddi括约肌切开(EST)或oddi括约肌气囊扩张(EPBD)胆总管取石,腹腔镜胆囊切除(LC),腹腔镜胆总管探查(LCBDE),术中、术后胆道镜,对86例胆囊结石合并胆管结石的病人进行微创治疗。结果82例手术获得成功,4例中转开腹,无胆道残余结石及严重并发症。术后住院时间明显缩短,操作熟练后手术时间也少于开腹手术。63例随访半年未见并发症。结论三镜联合的手术方式治疗胆囊结石合并胆管结石是切实可行和安全可靠的,其微创优势明显,可取代大部分开腹胆囊切除胆总管探查术。

Objective Sumamrize the experience in using minimally invasive surgery, laparoscopy,endoscopy and scopy to treat cholecystolithiasis with existing. Method From January 1996 to January 2004 we use the three kinds of endoscopies to treat 86 cases.Before operation, we use endoscopic retrograde cholangiopancreatography(ERCP)to exam,Using endoscopic sphincerotomy (EST)or endoscopic papillae balloon dilatation(EPBD)to take out the stones from common bile duct,laparoscopic cholecystectomy(LC),laparoscopic common bile duct exploratory(LCBDE). Results 82 cases are successful,4 cases have to change the traditional operation ,there are no bile stone left and no serious complication.Hospitalization becomes much shorter.Time spent on this operation will be shorter than that by traditional operation.Under the constant investigations,there are no complications in 63 cases duing half year. Conclusion Way of treating cholecystolithiasis with bile duct stones exiting by using the three kinds of endoscopies is successful and reliable.The method has an obvious advantage of minimally invasive surgery, it can take the place of most the traditional operation to cholecystectomy and exploratory of common bile duct.