腹腔镜联合内镜治疗胆管结石464例报告

BY LAPAROSCOPY AND ENDOSCOPY REPORT OF 464 CASES TREATMENT FOR BILE DUCT STONES

目的 :探讨腹腔镜联合内镜治疗胆管结石和胆管狭窄的方法、适应证和禁忌证。方法 :采用腹腔镜胆总管切开胆道镜探查取石术 (LCDE)或腹腔镜胆道镜探查取石球囊导管扩张胆管切口即时即缝合术 (LPBD)治疗胆管结石和胆管狭窄 ,联合内镜处理并发症。结果 :LCDE 45 7例 (包括阴性探查 18例 ) ;术后残石 39例 ,7例未取净 ,内镜取净 32例 ,胆漏 13例 ,鼻胆管引流 (ENBD)解除 9例 ,腹腔引流管持续少量胆漏非手术综合处理4例自愈 ,脓性胆管炎败血症急诊LCDE死亡 1例。LPBD 2 5例 ,3例原发性肝胆管结石狭窄解除 ,其中 1例左肝内胆管残石未取净 ;2 2例继发性胆总管结石乳头狭窄解除 ,结石取净。结论 :腹腔镜联合内镜治疗胆管结石和胆管狭窄 ,具有创伤小、有效。

Objective:To discuss the operative methods,indications and complications of multiple endoscopies were combined to extract the bile duct stones and treat the bile duct stenosis. Method:482 patients (in which include negative CBD exploration 18 cases)were admitted to have the procedures from Macrh 1992 to August 2000,i.e.endoscopic sphincterotomy,mechanical lithothipsy,nasobiliary drainage (duodenoscopy) was first adopted,then followed by laparsocopic CBD exploration and intrapoerative choledochoscopy to clear stons and remove gall bladder,for the CENTURION (CENTURION-PTA) Balloon dilatation Catherter Mnufactured by Vas-Cath and Bard USA:CT-7542～75102)to dilate the papillary stenosis and the intrahepatic bile duct stenosis.Postoperative choledochosocpic and duodenoscopic removed the bile duct residual stones or treated papillary stenosis and intrahepatic bile duct stenosis.Results:455 patients had completed successful duct clearance (98%) in total 464 patients which included the secondary bile duct stones 405 patiets and the primary bile duct stones 59 patients.292 patients were adopted the procedures of primary duct incision closure in total 482 patients (60%).1 patient of ACST died of MSOF.Conclusions:With the devleopment of laparoscopic technique,combined the wide spread use of Duodenoscopy and Choledochoscopy,the combined endoscopies of the kind is practicable and safe in hands of sophisticated endoscopists,and able to diminish or substitue some open choledocholithototomy and choledochojejunostomy for endoscopies.