内镜十二指肠乳头切开联合腹腔镜胆囊切除术治疗胆囊结石并胆总管结石

Endoscopic Sphincterotomy Combined with Laparoscopic Cholecystectomy in Treating Cholecystolithiasis with Choledocholithiasis

目的探讨运用腹腔镜胆囊切除术联合内镜十二指肠乳头切开术治疗胆囊结石并胆总管结石的方法。方法对胆囊结石并胆总管结石患者,92例行开腹胆囊切除+胆总管切开取石、T管引流术,86例行内镜下十二指肠乳头切开术(EST)+腹腔镜胆囊切除术(LC)。比较两种术式的临床效果、住院时间、并发症等。结果开腹组术中结石取净率为94.8%,住院时间为23.8±7.6d,术后并发胆瘘2例,肝功能衰竭1例,腹腔感染3例,肺部感染1例。内镜组有4例取石失败,改行开腹手术,余均取石成功,取石成功率为94%,住院时间为10.2±5.3d,并发胆道感染2例,十二指肠乳头出血3例。结论与传统开腹胆囊切除+胆总管切开取石、T管引流术相比,EST+LC治疗胆囊结石并胆总管结石具有创伤小、住院时间短、患者恢复快、并发症少等优点,临床效果可靠。EST与LC的联合应用可替代大部分开腹胆囊切除+胆总管切开取石、T管引流术。

Objective To explore the advantages of laparoscope combined with endoscope in extrahepatic bile duct cholelithiasis. Methods 92 among 178 patients with cholecystolithiasis and extrahepatic bile duct cholelithiasls were treated with open cholecystectomy and exploration of common bile duct, 86 cases treated with duodenal papillotomy and laparocopic cholecystectomy （ LC ）. The clinical effect, hospitalization and complication were compared. Results The stones in extrahepatic bile duct were cleaned up in 91 cases of open operation group （94%） during the operation, the hospitalization days were 23.8 ± 7.6 days, 2 case happened gallubladder fistula, 1 case happened liver function failure, 1 case happened abdominal cavity infects, 1 case happened lungs infects, operations were performed in 4 cases, and 86 cases（95% ） were succeeded. The hospitalization days were 10.2 ＋5.3 days, 2 case happened biliary duct infects, 2 case happened duodenum nipple appears blood. Conclusion Compared with traditional cholecystectomy and exploration of common bile duct, EST ＋ LC has the virtue of little trauma, short hospltalizatong days, fast recovery and little complications. Duodenal papillolithotomy ＋ LC can be used in most of patients with cholecystolithiasis and ex- trahrpatic bile duct cholelithiasis.