双镜联合治疗肝硬化患者胆囊结石和胆总管结石的疗效分析

Combined endoscopic and laparoscopic treatment in liver cirrhosis patients with cholecystolithiasis and choledocholithiasis

目的观察双镜联合（内镜下乳头切开取石联合腹腔镜胆囊切除）治疗肝硬化患者胆囊结石和胆总管结石的临床疗效。方法回顾性分析51例肝硬化患者胆囊结石和胆总管结石行双镜联合治疗的临床资料。结果双镜联合组取石成功率为90．2％，围手术期并发症发生率为15．7％、死亡率为5．9％；术前肝功能ChildC级患者的并发症发生率及死亡率均高于ChildA、B级患者。术后平均随访67．9个月，随访期内胆管炎发作2例、胆总管结石复发4例及迟发型胰腺炎1例。结论双镜联合治疗刨伤小、疗效满意，拓展了胆道微创手术范围，可作为ChildA、B级患者胆囊结石和胆总管结石的一线治疗方案。对ChildC级患者应重视围手术期处理，尽量将肝功能调整至ChildB级再行双镜联合治疗。

Objective To study the clinical therapeutic efficacy of the combined endoscopic sphincterotomy and laparoscopic eholecysyectomy （CEPLC） in liver cirrhosis patients with eholecystolithiasis and choledocholithiasis. Methods The clinical data of 51 patients of liver cirrhosis with cholecystolithiasis and choledocholithiasis treated by CEPLC were retrospectively analyzed. Results The procedure - related complications rate and mortality was 15.7% and 5.9% respectively. When patients were further grouped according to Child - Pugh classification, significant difference in rates of procedure - related complications and mortality were detected between the Child - Pugh C patients and the Child - Pugh A or B patients. Patients were followed up periodically from 27 to 154 months （mean,67.9 months）, and there were 2 cases of cholangitis,4 cases of recurrent choledocholithiasis and 1 case of delayed pancreatitis during the follow - up. Conclusion The method of CEPLC can serve as the primary therapy for patients of liver cirrhosis （ Child - Pugh A or B） with cholecystolithiasis and choledocholithiasis because of its minimal invasion characteristic and satisfactory resuhs, besides it can expand the utilization of minimally invasire treatment in bile duct diseases. However, more attention should be paid to the perioperative management of liver cirrhosis patients （ Child - Pugh C）, and their liver function should be improved to Child - Pugh B before CEPLC.