腹腔镜胆囊切除和内镜Oddi括约肌切开一期治疗胆道结石

Single stage laparoscopic cholecystectomy and endoscopic sphincterotomy for management of patients with cholecystocholedocholithiasis

目的 探讨联合应用腹腔镜胆囊切除术 (laparoscopiccholecystectomy,LC)和内镜Oddi括约肌切开术 (endoscopicsphincterotomy,EST)一期治疗胆囊和胆管结石病的方法和价值。方法 对 10例LC术中经胆囊管插管造影发现胆总管结石的病人 (3例术前已诊断为胆管结石 ) ,在全麻下一期行LC和EST清除胆管结石。结果 10例病人LC和EST均顺利完成 ,总的手术时间为 1 5～ 3h,术中和术后无严重并发症发生 ,术后 2～5d出院。结论 联合应用LC和EST一期治疗胆囊和胆管结石病切实可行 ,该法具有手术成功率高、病人痛苦少和住院时间短的优点。

Objective To evaluate the effect of combined laparoscopic cholecystectomy (LC) and endoscopic sphincterotomy (EST) for a single session treatment of patients with cholecystocholedocholithiasis.Methods From Dec.1997 to Aug.1998,10 cases with cholecystocholedocholithiasis underwent LC and EST as a combined procedure under general anesthesia.Three out of the 10 cases were preoperatively diagnosed as having concommitant gall stones and cholelithiasis,the remaining patients were found with stones in CBD by intraoperative cholangiography during LC.Results The procedures were successfully accomplished in all patients. The operative time for the combined procedure ranged 1.5～3 hours.No severe complications of EST or LC were observed. The postoperative hospital stay ranged 2～5 days.Conclusions The single stage of LC and EST is the therapy of choice for cholecystocholedocholithiasis in patients undergoing LC,which preserving the minimally invasive appoach has the merit of high successful rate,less injury and short hospital stay.