腹腔镜胆囊切除术中十二指肠镜下乳头切开取石术98例报告

Clinical application of duodenoscopic papillotomy in laparoscopic cholecystectomy

目的探讨腹腔镜胆囊切除术中十二指肠镜下乳头切开取石术治疗胆囊结石继发胆总管结石的手术方法和适应证。方法腹腔镜下行胆囊切除术,经胆囊管残端插入输尿管导管或斑马导丝至十二指肠腔,经口插入十二指肠镜至十二指肠乳头,针式刀或弓式刀在输尿管导管或斑马导丝指引下对乳头施行切开术,用十二指肠镜取石网或球囊取石。结果施行术中十二指肠镜下乳头切开术98例,89例乳头切开取石成功,4例乳头切开成功,5例中转为其他术式。术后轻症胰腺炎7例。无肠穿孔、胆管穿孔、大出血、重症胰腺炎等严重并发症,无死亡。结论只要选择合适的病例,腹腔镜胆囊切除术中十二指肠镜下乳头切开取石术是可行、有效和安全的。

Objective To explore the operative methods and indications of duodenoscopic papillotomy in laparoscopic cholecystectomy（LEST）. Methods To accomplish cholecystectomy, uretic catheter and zebra guidewire of cholecystic duct remnant were introduced tinto the common bile duct and duodenum, and with a duodenoscop introduced orally into the papillary of duodenum, the stones of the common bile duct were removed with the balloon of duodenoscopy. Results LEST was successful in 93 out of 98 patients. Five patients were shifted to other operations. Seven patients had slight pancreatitis. Perforation of the intestine and bile duct, bleeding, severe pancreatitis and death were not observed. Conclusions If patients are indicated, LEST is safe and effective.