内镜联合腹腔镜治疗胆囊结石合并肝外胆管结石

Endoscopy combined with laparoscopy in treating cholecystolithiasis and extrahepatic bile duct cholelithiasis

目的 :探讨运用内镜联合腹腔镜治疗肝外胆管结石的方法。方法 :对胆囊结石合并胆总管结石患者 ,5 1例行开腹胆囊切除 +胆总管探查术 ,4 0例行内镜下十二指肠乳头切开取石术 (EST) +腹腔镜胆囊切除术 (LC) ,比较两者临床疗效、住院时间、并发症等。结果 :开腹组术中结石取净率为 88 2 % ,住院时间为2 1.9± 7.2d ,术后并发切口感染 1例。内镜组中有 2例取石失败 ,改行开腹 ,余均取石成功 ,取石成功率为95 % ,住院时间为 10 3± 4 5d ,无严重并发症。结论 :与传统的开腹胆囊切除加胆总管探查术相比 ,EST +LC治疗胆囊结石合并肝外胆管结石具有创伤小、住院时间短、患者康复快、并发症少等优点 。

Objective:To explore the value of laparoscope combined with endoscope in extrahepatic bile duct cholelithiasis.Methods:51 among 91 patients with cholecystolithiasis and extrahepatic bile duct cholelithiasis were treated with open cholecystectomy and exploration of common bile duct,40 cases treated with duodenal papillolithotomy and laparoscopic cholecystectomy (LC). The clinical effect, hospitalization and complication were compared.Results:The stones in extrahepatic bile duct were cleaned up in 45 cases of open operation group (88.2%) during the operation, the hospitalization days were 21.9±7.2 days, 1 case happened incisions infection. Open operations were performed in 2 cases, and 38 cases(95%) were succeeded, the hospitalization days were 10.3 ±4.5 days, there were no severe complications.Conclusions:compared with traditional cholecystectomy and exploration of common bile duct, EST+LC has the virtue of little trauma, short hospitalization days, fast recovery and little complications. duodenal papillolithotomy +LC can be used in most of patients with cholecystolithiasis and extrahepatic bile duct cholelithiasis.