三镜同期联合手术治疗胆结石174例分析

Combined application of three mirrors in laparoscopic surgery for gallstones:Report of 174 cases

目的总结运用腹腔镜、胆道镜、十二指肠镜(三镜)同期联合手术治疗胆囊结石、胆总管结石和乳头狭窄,及扩大一期缝合术应用范围的经验。方法回顾性分析2000年9月至2012年10月胆囊结石合并胆总管结石患者,在腹腔镜下行胆囊切除术、胆总管切开、胆道镜取石、液电碎石,经腹胆道镜钳道插入输尿管导管或斑马导丝至十二指肠腔,经口十二指肠镜行乳头切开术,一期缝合胆总管切口的手术疗效。结果扩大一期缝合术应用范围174例患者,术中成功切除胆囊和取净胆总管结石174例。172例患者乳头狭窄切开成功,施行了一期缝合术,2例乳头狭窄切开失败者改为T管引流术。术后并发症总发生率4.0%(7/174),术后发生胰腺炎3例;发生胆漏4例,经腹腔引流管引流痊愈;无严重并发症,无死亡。结论选择适宜的患者,采用三镜同期手术扩大一期缝合术应用范围是可行、有效和安全的。

Objective To investigate the combined application of laparoscopy, choledochoscopy, duodenoscopy （three mirrors） in surgical treatment of cholecystolithiasis, choledocholithiasis and papillary stenosis, and to explore the primary suture of the common bile duct. Methods From September 2000 to October 2012, patients with gallbladder and bile duct stones received laparoscopic cholecystectomy, including common bile duct exploration, removal of gallstones by choledochoscopic electrohydraulic lithotripsy, transabdominal choledochoscopic forceps channel, insertion of a ureteral catheter or zebra guidewire to the duodenal lumen, oral endoscopic sphincterotomy, and primary suture of the common bile duct. A retrospective analysis of clinical data of 174 patients was made at last. Results The scope of application of primary suture was expanded in 174 patients, and intraoperative resection of gallbladder and bile duct stones was performed successfully in all 174 patients. In this series, 172 patients with papillary stenosis underwent endoscopic sphincterotomy successfully and had primary suture of the common bile duct, but the remaining 2 patients received T tube drainage. The morbidity rate of the174 patients was 4.0% （7 patients）, including postoperative pancreatitis in 3 patients. Four patients had bile leakage, which was treated by percutaneous drainage with no serious complications and death. Conclusion In properly selected patients, combined application of three mirrors in laparoscopic surgery is feasible, effective and safe.