十二指肠镜、腹腔镜联合治疗肝外胆管结石

Combined use of duodenoscopy and laparoscopy for treatment of calculus of extrahepatic bile duct

目的探讨十二指肠镜联合腹腔镜治疗胆囊结石并胆管结石的临床效果。方法回顾分析7年间106例胆囊结石并胆管结石患者的临床资料。106例均先行内镜下十二指肠乳头切开(EST)取石、鼻胆引流(ENBD)然后行腹腔镜胆囊切除术(LC)。结果EST取石成功101例(95.3%);并发症包括胰腺炎(高淀粉酶血症)11例(10.4%),出血1例,急性胆管炎2例,均经对症处理治愈。全组病例无死亡,均痊愈出院。85例获平均3.1年随访,术后复发胆管结石5例(5.9%),十二指肠乳突部再狭窄1例;另发生胆管癌2例,其他原因死亡2例。结论联合EST和LC治疗肝外胆管结石是一种安全有效的微创手术方法。

Objective To discuss the clinical effect of combined use of duodenoscopy and laparoscopy for treatment of cholecystolithiasis complicated by choledocholithiasis. Methods The clinical data of 106 cases of cholecystolithiasis with cholelcoholithiasis in our department during 7 years were analyzed. Endoscopic sphincteromy （ EST ） and endoscopic nasobiliary drainage （ ENBD ） , followed by laparoscopic cholecystectomy （LC） was employed. Results In 101 cases （95. 3 % ） stones were removed by EST successfully. Complicated with postoperative pancreatitis in 11 cases （ 10.4 % ） , bleeding in 1 case （ 0.9 % ） , and acute cholangitis in 2 cases （ 1. 9 % ）. All of the patients recovered and discharged. Eighty-five cases were followed up for average 3. 1 years. Of them, 5 cases had choledocholithiasis recurrence, 1 had papillary re-stenosis, 2 had bile duct carcinoma, and 2 died of other caused. Conclusions Combined use of EST and LC for treatment of calculus of extrahepatic bile duct is a safe and effective mini-intrusive operation.