腹腔镜与开腹手术治疗胆囊并胆总管结石的内镜应用

THE APPLICATION OF ENDOSCOPE IN LAPAROSCOPIC AND OPEN SURGERY FOR CHOLELITHIASIS

目的探讨内镜参与腹腔镜胆囊切除术(LC)、开腹手术治疗胆囊并胆总管结石的效果。方法对54例胆囊并胆总管结石病人在LC或开腹手术之前行内镜检查、取石。结果 54例十二指肠逆行胰胆管造影(ERCP)均成功,选择性十二指肠乳头括约肌切开术(EST)取胆总管结石成功49例,占90.74%。EST后选择性LC成功47例,内镜加LC总取石成功者占87.05%,1例EST取石后急性胆囊炎加重中转手术;内镜术后选择性开腹手术成功7例,占12.95%。无严重并发症发生。结论先行内镜检查、取石,再行LC处理,大部分胆囊并胆总管结石病人可治愈而且并发症少,少部分疑难、复杂者仍需开腹手术处理。

Objective To evaluate the effect of an endoscope in laparoscopic and open surgery for therapy of eholelithia- sis. Methods Fifty-four patients with cholecystolithiasis complicated with choledocholithiasis underwent endoscopic examination and removal of the stones before laparoscopic cholelithotomy （LC） or open surgery. Results Of 54 patients who underwent endoscopic retrograde eholangiopancreatography （ERCP） was succeeded; selective sphineterotomy for removal of common duet stones succeeded in 49 cases, and LC was succeeded in 47 after removal of common duct stones, of which, one was converted to open due to aggravation of acute cholecystitis. Seven cases successfully underwent selected open surgery after endoscopic procedure. No serious complications were encountered. Conclusion Most of the cholelithiasis can be cured by endoscopic examination and stone removal first, and then followed by LC with few complications, for a few complicated cases, an open surgery is still required.