腹腔镜、胆管镜、十二指肠镜同期治疗肝外胆管结石合并Oddi括约肌狭窄

The combination operation of laparoscopy,choledochoscopy and duodenoscopy for treatment of extrahepatic bile duct stones and stenosis of sphincter Oddi during the course of therapeutic laparoscopy: a report of 103 cases.

目的总结运用腹腔镜、胆管镜、十二指肠镜(三镜)同期治疗肝外胆管结石合并Oddi括约肌狭窄的临床经验。方法腹腔镜下行胆囊切除、胆总管切开,胆管镜下行探查取石术,经胆总管切口插入输尿管导管或斑马导丝至十二指肠腔,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或斑马导丝指引下施行Oddi括约肌切开术。结果施行三镜同期联合手术103例,切除胆囊103例,取净胆总管结石101例,2例胆总管残留结石置T管引流,术后经胆管镜和液电碎石取净。98例Oddi括约肌狭窄切开成功,5例Oddi括约肌狭窄中转为其他术式。术后轻症胰腺炎2例。术后胆漏2例,经术中常规放置的腹腔引流管引流治愈。无肠穿孔、胆管穿孔、大出血、重症胰腺炎等并发症,无死亡。结论只要选择合适的病例,三镜同期治疗肝外胆管结石合并Oddi括约肌狭窄是可行、有效和安全的。

Objective To summarize the clinic experience of the combination operation of laparoscopy, cboledochoscopy and duodenoscopy for treatment of extrahepatic bile duct stones and stenosis of sphincter Oddi during the course of therapeutic laparoscopy （LEST）. Methods To accomplish laparoscopic cholecystectomy and common bile duct exploration by choledochoscopy firstly, through ureteric catheter and zebra guidewire of common bile duct incision into duodenum, through duodenoscopy via oral into the papillary of duodenum, were used to cut through the stenosis of sphincter Oddi for electro-knife by pin-head-hke to track along the ureteric catheter and zebra guidewire. Results It was successful in 103 cases removing the gallbladder and 101 cases removing the common bile duct residual stones out of 103 cases. Two cases were residual stones with T tube drainage then cured by post-operation choledochoscopic exploration and electrohydralic lithothipsy. Sphineterotomy was successful in 98 out of 103 cases, five cases were shifted to other operation, Two patients were a slight pancreatitis. Bile leakage of primary closure of duct incision was cured by patent drainage in 2 cases. No cases had pedoralion of intestine and bile duct, bleeding, severe pancreatitis and death. Conclusions If patients are suitable, LEST is sale and effective.