胆囊结石合并胆总管结石的微创外科治疗进展

Minimally invasive surgery technology of gallbladder stones com-bined bile duct stones

胆石症包括胆囊结石、胆总管结石和肝内胆管结石。胆囊结石合并胆总管结石占胆石症的9．2％～14．3％，当前临床常用的治疗方法包括传统的开腹胆囊切除及胆总管切开取石＋T管引流术（Opencholecystectomych01edocholiIhotomyandT—tubedrainage，OC—OCHTD）；经内镜逆行胰胆管造影（ERCP）十内镜下括约肌切开取石（EST），二期腹腔镜胆囊切除术（LC）（即ERCP／EST＋Lc）；同期腹腔镜胆囊切除＋胆总管切开取石（LCBDE），这三种术式各有特点。与传统的开腹手术比较，后两者为微创手术治疗方法，体现了微创技术的优势，但手术适应证和操作技术需要不断总结和提高。目前，关于后两种做创方法治疗的文献报道较多，在诸如手术适应证、住院费用、手术时间、治疗风险、并发症、住院时间等方面存在一定争议。比较LCBDE和ERCP／EST＋Lc，两者各有优缺点。但是在符合适应证的情况下，LCBDE是一期治疗胆囊结石合并胆总管结石患者的首选方法。对患者而言，无论哪种手术方案，创伤小、操作安全、并发症少的方法才是最适合的治疗手段。

While Choledocholithiasis is concomitant with gallstones in approximately 9.2% -14.3% of the pa- tients, and its treatment methods are mainly by surgery, including： （ 1 ） Open choleeystectomy and open choledo- eholithotomy ,T-tube drainage （OC-OCHTD） ; （ 2 ） Endoscopic retrograde cholangiopancreatography （ ERCP ） and Endoscopic sphincterotomy （EST） , and followed by Laparoscopic cholecystectomy （LC） se（：ond stage （ERCP/ EST ＋ LC） ; （3） Laparoscopic cholecystectomy combined with laparoscopic common bile duct exploration （LC ＋ CBDE）. These three methods all have their own characteristics. The last two methods are minimally invasive sur- gery treatment. Practice has proved that LCBDE and ERCP ＋ EST ＋ LC treatment methods are feasible and showcertain advantages, compared with OC-OCHTD reflecting the development of minimally invasive surgeU. Praetice has proved that LCBDE and ERCP ＋ EST ＋ LC treatment methods are feasible and show certain advantages, com- pared with OCHTD reflecting the development of minimally invasive surgery. But the indiealions of operation are need to be summarized constantly in clinical praetice, while operation skills are also need to he improved. At pres- ent, many reporls of the two methods of minimally invasive treatment have been published because of the controver- sy, sueh as surgical indications, hospitalization expense, operation time, therapy danger, eompliealions and the length of hospital stay. Both LCBDE and ERCP ＋ EST ＋ LC show some advantages and disadvantages compared with each other. On proper indications, LCBDE embodies the superiority of minimally invasive surgry technology as a one- stage operation, which is preferred for patients of eholedocholithiasis with concomitant gallstones. For patients, no matter what kind of operation method, less invasion, lower risk and less eomplieations is the key for best treal- ment ehoise.