3镜联合治疗胆囊结石合并肝外胆管结石的探讨

Exploration of the combination of laparoscopy,duodenoscopy and choledochoscopy for cholecyslithiasis with choledocholithiasis

目的探讨腹腔镜、十二指肠镜、胆道镜3镜联合治疗胆囊结石并肝外胆管结石的方法及临床意义。方法回顾性分析该院2008年1月～2010年9月行腹腔镜胆囊切除术(LC)和经内镜乳头括约肌切开术(EST)或腹腔镜胆道探查术(LCDE)治疗胆道结石128例的临床资料。其中,先行电子十二指肠镜逆行胰胆管造影(ERCP)和(或)EST,3～5d后行LC85例;先行LC,5～7d后行内镜逆行胰胆管造影和(或)EST5例;同时行LC和LCDE38例。结果 128例患者手术成功,术后3～7d拔管出院,无手术死亡病例,无术后漏胆、上消化道出血、穿孔及急性胰腺炎发生。结论腹腔镜、十二指肠镜、胆道镜3镜联合治疗胆囊结石并肝外胆管结石是一种创伤小、恢复快及安全可靠的方法。

Objective To discuss the clinical significance of the treatment of cholecystolithiasis combined with choledocholithiasis by the combination of laparoscopy,duodenoscopy and choledochoscopy.Methods The clinical data of 128 patients with choledocholithiasis underwent laparoscopic cholecystectomy （LC）,endoscopic sphincterotomy （EST） and laparoscopic common bile duct exploration （LCDE） from Jan.2008 to Sep.2010 were retrospectively analyzed.85 cases underwent endoscopic retrograde cholangiopancreatography （ERCP）/EST at first,and received LC 3～5 days later.5 cases underwent LC at first,and received ERCP/EST 5～7 days later.38 cases received LC and LCDE at the same time.Results 128 cases succeeded and 5～7 days later,left hospital after the tube taken away.No death,no bile leakage,no bleeding or perforation of upper digestive tract,and no acute pancreatitis happened after operation.Conclusion Laparoscopy combined with duodenoscopy and choledochoscopy is a safe,effective and quickly recovering method for the treatment of cholecyslithiasis combined with choledocholithiasis.