LC联合内镜EST治疗胆囊结石并发胆总管结石的临床研究(附76例报告)

Study on Laparoscopic Cholecystectomy Combined with Endoscopic Sphincterotomy in the Treatment of Cholecystolithiasis Associated with Choledocholithiasis

目的:探讨腹腔镜胆囊切除术(LC)与内镜十二指肠乳头括约肌切开术(EST)联合应用治疗胆囊结石合并胆总管结石的临床效果。方法:回顾性分析我院开展的LC联合EST治疗胆囊结石合并胆总管结石76例,其中56例先行EST后行LC,20例先行LC后行ERCP/EST。结果:本组全部治愈,先行EST组56例,3例并发胰腺炎,3例出血,2例再发胆总管结石,先行LC组20例行EST11例,6例取石后未做括约肌切开,3例结石自行掉入肠道,1例出现胆道感染,1例胰腺炎,无出血及穿孔。结论:内镜治疗胆囊结石继发胆总管结石具有创伤小、效果好、并发症少、恢复快的的特点;先作EST可解除胆道梗阻、减轻炎症,并为LC创造条件,选择性先行LC后可减轻创伤,甚至不必做EST。

Objective： To study the therapeutic efficts of combined with laparoscopic cholecystectomy（LC） and endoscopic sphincterotomy（EST） for the treatment of eholecystolithiasis associated with eholedocholithiasis. Methods： The data of 76 cases of cholecystolithiasis associated with choledocholithiasis treated by combining with LC and EST in our hospital were reviewed,including 56 cases that EST first and LC secondly,20 cases that LC first and ERCP or EST secondly. Results：All patients were cured in this group. There were 3 cases of acute pancreatitis,3 cases of bleeding in the papilla of dudenum and 2 cases of stones reoccurred in the common bile duct in the group of 56 cases which EST be done first;11 cases be done EST, paillasphinctertomy not be done after stones be removed in 6 cases and there were 3 cases that stones enter the intestinal tract automatically in whole 20 cases, one acute pancreatitis and one biliary infectionin, no bleeding or perforation in intestinal tract in this group. Conclusion： The method of combined laparoseopie cholecystectomy and endoscopic paillasphinctertomy can give good therapeutic results for the treatment of cholecystolithiasis associated with choledocholithiasis and it has advantages of less trauma, few complications and quick recovery. Doing EST first can relieve the obstuctiou of hiliary tract and reduce the digree of inflammation, create much better eontion for LC; Doing LC first selectively can reduce the damage, sometimes no need to do EST.