多镜联合治疗肝外胆管结石3780例

Combined application of laparoscope and multiple endoscopes for the treatment of extra-hepatic bile duct stones： a report of 3780 cases

目的探讨腹腔镜、胆道镜、十二指肠镜联合治疗肝外胆管结石的方法及疗效。方法回顾性分析1998年3月至2010年6月兰州大学第一医院收治的3780例肝外胆管结石患者的临床资料，根据患者胆管结石不同位置和采用腹腔镜、胆道镜、十二指肠镜的情况，将患者分为“一镜”、“二镜”、“三镜”治疗组；通过患者治疗后的影像学检查和随访结果，比较3组患者治疗的成功率和并发症的发生率。结果“一镜”治疗组1425例患者，成功率为89．54％（1276／1425），并发症发生率为6．73％（86／1276）；149例治疗失败，其中83例接受“二镜”治疗、66例接受“三镜”治疗。“二镜”治疗组1792例患者（含转入83例），成功率为95．93％（1719／1792），并发症发生率为4．07％（70／1719）；73例治疗失败（转入“三镜”治疗组）。“三镜”治疗组785例（含转入139例）患者，成功率为99．75％（783／785），并发症发生率为0．26％（2／783）；2例治疗失败患者选择开腹手术治疗。结论腹腔镜、胆道镜、十二指肠镜联合应用治疗肝外胆管结石可以优势互补，明显提高结石取尽成功率，降低术后并发症的发生率。

Objective To investigate the efficacy of combined application of laparoscope and multiple endoscopes for the treatment of extra-hepatic bile duct stones. Methods The clinical data of 3780 patients with extra-hepatic bile duct stones who were admitted to the First Hospital of Lanzhou University from March 1998 to June 2010 were retrospectively analyzed. According to the condition of bile duct stones, laparoscope, choledochoscope and duodenoscope were applied separately or combinately. All patients were divided into A, B and C groups. Patients in group A were treated by laparoscopy, choledochoscopy or duodenoscopy; patients in group B were treated by choledochoscopy ＋ duodenoscopy, duodenoscopy ＋ laparoscopy or laparoscopy ＋ choledochoscopy; patients in group C were treated by laparoscopy ＋ duodenoscopy ＋ choledochoscopy. The efficacies of different treatment approaches were analyzed by comparing the results of imaging examination and follow-up. Results The curative rate and complication rate of the group A were 89.54% （1276/1425） and 6.73% （86/1276）, respectively. Of the 149 patients in the group A who were failed in the treatment, 83 patients were transferred to the group B, and 66 patients were transferred to the group C. The curative rate and complication rate of the group B （ including 83 patients transferred from the group A） were 95.93% （1719/1792） and 4.07% （70/1719）, respectively, and 73 patients who were failed in the treatment were transferred to the group C. The curative rate and complication rate of the group C （including 139 patients transferred from the group C） were 99.75% （783/785） and 0.26% （2/783）, respectively, and 2 patients who were failed in the treatment received open surgery. Conclusion Combined application of laparoscope and endoseopes could raise the success rate of stone clearance and decrease the postoperative complications.