三镜联合治疗胆囊结石合并胆总管结石的体会

Experience in the combined three endoscopes in treating choledocholithiasis associate with cholecystolithiasis

目的探讨三镜联合应用在治疗胆囊结石合并胆总管结石的疗效。方法回顾性分析我院2010年10月至2011年10月期间收治的胆囊结石合并胆总管结石患者共52例,通过不同的治疗方法分析手术疗效及安全性。结果 52例患者中,通过腹腔镜胆囊切除术(LC)+腹腔镜胆总管探查取石术(LCBDE)方案治疗24例,中转开腹2例;十二指肠乳头切开取石术(EST)+LC方案治疗25例;内镜鼻胆管引流术(ENBD)+LC+LCBDE方案治疗3例。52例术后均未出现胆漏,出血,胰腺炎,胆管炎及残留结石等并发症。结论胆囊结石合并胆总管结石患者根据术前检查选择三镜最优组合集中了三种治疗手段的优势,是目前治疗该病创伤最小的方法,疗效是肯定的。

Objective To study the curative effects for treating choledocholithiasis associated with cholecystolithiasis by the combined three endoscopic methods. Methods Clinical data of 52 patients with choledocholithiasis and cholecystolithiasis in our hospital from October 2010 to October 2011 were retrospectively analyzed. Through the different treatment methods including laparoscopic cholecystectomy （LC）, laparoscopic common bile duct exploration （LCBDE） and endoscopic nasobiliary drainage （ENBD）, the effect and safety were analyzed. Results In this group of 52 patients, 24 were treated by LC＋LCBDE, 2 of them converted to laparotomy. Twenty five patients were treated by EST＋LC. Three patients were treated by ENBD＋LC＋LCBDE. None of the 52 patients appeared the complication of bile leakage, bleeding, pancreatitis, cholangitis or residual stones. Conclusion Selecting the optimal combination of the endoscopes is to concentrate the advantages of the three endoscopes in treating the patients with cholecystolithiasis assciated wtih chloecystolithiasis. It has minimal trauma and a confirmed efficacy.