联合微创治疗胆囊合并胆总管结石82例临床分析

Combinative Minimally Invasive Treatment for 82 Patients with Gallbladder and Common Duct Stones

目的探讨联合应用十二指肠镜,腹腔镜微创治疗胆囊结石合并胆总管结石的手术疗效及其并发症的防治.方法回顾性分析2a来收治胆囊合并胆总管结石82例的临床资料,行十二指肠镜Oddi括约肌切开术(EST)70例、其中ENBD+EST3例,十二指肠镜Oddi括约肌气囊扩张术(EPBD)12例,内镜下尽量取净胆总管结石,48～72h后成功实施LC切除胆囊达到治疗目的.结果所有患者均联合微创治疗,3例残余胆道结石再次行EST取石获痊愈,全部病例未发生胆管损伤、肠管损伤、胆汁性腹膜炎、腹腔脓肿等严重并发症,术后住院时间为4～6d,平均住院时间5d.结论EPBD或EST+LC联合应用治疗胆囊合并胆总管结石疗效肯定,具有创伤小、恢复快、并发症少等优点,临床上有很好的推广应用价值.

Objective To discuss surgical effects of combination of duodenoscopic and laparoscopic minimally invasive treatment for gallbladder and common duct stones as well as prevention and treatment of caused complications. Methods A retrospective analysis was conducted on the clinical documents of 82 patients with gallbladder and common duct stones in two years. Endoscopic sphincterectomy （EST） was performed on 70 patients, and endoscopic papilliary balloon dilatation （EPBD） on 12 patients. 3 of 70 were treated with combination of EST and endoscopic nasobiliary drainage （ENBD）. Common duct stones were extracted endoscopically. Laparoscopic cholecystectomy （LC） was successfully conducted after 48 - 72 hours. Results Combinative minimally invasive treatment was performed on all patients. 3 patients with residual biliary calculi were totally recovered after receiving one more EST. No severe complications, including bile duct injuries, choleperitonitis and intraperitoneal abscess, were observed in all cases. The length of hospital stay after surgery was 4 to 6 days with an average of 5 days. Conclusion Good effects can be achieved with EPBD or EST and LC for gallbladder and common duct stones. The method has the features of minimal invasion, rapid recovery and few complications. It is worthy of clinical promotion among hospitals.