腹腔镜胆囊切除术术中联合十二指肠镜治疗正常直径胆总管结石158例

The stones are removed from a detail choledochus by duodenoscopic papillotomy during the course of laparoscopic cholecystectomy:a report of 158 cases

目的探讨腹腔镜胆囊切除术术中联合十二指肠镜下乳头切开取石术治疗胆囊结石继发细径胆总管结石的手术方法和适应证。方法腹腔镜胆囊切除术术中联合十二指肠镜治疗158例正常直径胆总管结石,完成腹腔镜胆囊切除后,经胆囊管残端插入输尿管导管至十二指肠肠腔,经口插入十二指肠镜至十二指肠乳头,针式刀在输尿管导管引导下施行乳头切开术,用十二指肠镜取石网或球囊取石。结果 158例患者中,行乳头切开取石140例,乳头切开排石15例,中转为其他术式3例。术后轻症胰腺炎9例,胆管残留结石3例。无肠穿孔、胆管穿孔、胆漏、大出血、重症胰腺炎等并发症发生,无死亡病例。结论只要选择合适的病例,腹腔镜胆囊切除术术中联合十二指肠镜下乳头切开取石术治疗胆囊结石继发细径胆总管结石是可行、有效和安全的。

Objective To explore the operative methods and indications that the stones are removed from a detail choledochus by duodenoscopic papillotomy during the course of laparoscopic cholecystectomy（LECT）.Methods To accomplish cholecystectomy,ureteric catheter of cholecystic duct remnant were introduced into the common bile duct and duodenum,and with a duodenoscopy introduced orally into the papillary of duodenum,the papillary of duodenum were cut through the electro-knife by pin-head-like to track along the ureteric catheter,the stones of the common bile duct were removeded with the reticulation and the balloon of duodenoscopy.Results LECT was performed on 158 cases.The stones of common bile duct removed with duodenoscopic papillotomy had 140 cases,the stone expulsion after duodenoscopic papillotomy had 15 cases,three cases were shifted to other operation.Nine cases were a slight pancreatitis after operation,three cases were residual stones then no cured during hospitalization and follow-up examination.No cases had perforation of intestine and bile duct,bile leakage,bleeding,severe pancreatitis and death.Conclusions If patients are indicated,LECT is safe and effective to removing the stones of detail choledochus.