LC联合术中ERCP一期治疗胆囊结石合并胆总管结石的临床分析

LC combined with intraoperative ERCP for the onestage treatment of gallbladder stone with choledocholithiasis

目的探讨腹腔镜胆囊切除术(LC)联合术中内镜下逆行胆胰管造影(ERCP)及乳头切开(EST)取石一期治疗胆囊结石合并肝外胆管结石的可行性和安全性。方法回顾分析应用LC联合术中ERCP一期治疗胆囊结石合并肝外胆管结石36例的临床资料,分析原发病、手术方式、术后康复、住院时间及并发症。结果术前明确胆总管结石31例中10例先行术中ERCP取石,取石成功后再行LC;余21例和5例术前怀疑胆总管结石、术中经胆囊管胆道造影(TCC)证实胆总管结石者先行LC,继而行ERCP取石。LC手术均获成功,ERCP取石成功率为97.22%。术后5例出现一过性血淀粉酶升高,无明显出血、胆漏等并发症,术后住院平均为4 d。结论 LC联合术中ERCP一期治疗胆囊结石合并肝外胆管结石安全、有效,可避免不必要的ERCP及因术后ERCP失败而致患者再次手术。

Objective To explore the feasibility and safety of LC combined with intraoperative ERCP for the onestage treatment of gallbladder stone with choledocholithiasis.Methods Thirty-six patients with gallbladder stone and choledocholithiasis were treated with the combined procedures and the operation,postoperative recovery,hospital stay,and complications were retrospectively analysed.Results 10 of 31 patients with preoperative diagnosed choledocholithiasis were successfully treated by ERCP at first,then underwent LC.Other 21 patients and 5 patients with suspected choledocholithiasis comfirmed by TCC were treated by LC at first,then underwent ERCP.ERCP was performed successfully in 35 cases（97.22%）.5 patients had postoperative hyperamylasemia temporarily,no other complications occurred.Mean postoperative hospitalization was 4 days.Conclusion Combined LC/ERCP can be performed safely,and there are advantages including onestage treatment,avoidance of unnecessary preoperative ERCP,and eliminating the need to return to the operation as the failure of postoperative ERCP.