腹腔镜术中联合十二指肠镜一期治疗胆囊结石合并胆总管结石80例报告

Laparoscopy combined with duodenoscopy for one-stage management of cholecystolithiasis complicated with choledocholithiasis: a report of 80 cases

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)术中联合十二指肠镜乳头扩张(endoscopic papillary balloon dilatation,EPBD)取石术治疗胆囊结石合并胆总管结石的手术方法及适应证。方法:为80例胆囊结石合并胆总管结石患者行LC+EPBD,完成腹腔镜胆囊三角游离后,经胆囊管插入导丝至十二指肠肠腔,经口插入十二指肠镜至十二指肠乳头,扩张球囊在导丝引导下行EPBD,用取石网或球囊取石,再行LC。结果:79例成功完成手术,成功率98.75%,1例中转开腹。手术时间平均(95.04±13.49)min,术后平均住院(4.82±0.76)d。术后发生高淀粉酶血症11例,无死亡病例及胆管残留结石、肠穿孔、胆管穿孔、胆漏、大出血、重症胰腺炎等严重并发症发生。79例获得随访,平均随访(9.12±2.87)个月,B超、肝功能检查均未见明显异常。结论:术前选择合适的病例,综合考虑术者的技术水平及医院设备条件,为胆囊结石合并胆总管结石患者行LC+EPBD是可行、有效、安全的,具有住院时间短、保留Oddi括约肌功能、术后并发症少等优点。

Objective： To investigate the operative methods and indications of the one-stage management with laparoscopic cholecystectomy（ LC） plus endoscopic papillary balloon dilatation（ EPBD） for cholecystolithiasis and choledocholithiasis. Methods： Eighty patients with cholecystolithiasis and choledocholithiasis underwent LC ＋ EPBD. To accomplish laparoscopic Calot triangle dissection,guidewire of cholecystic duct was introduced into the common bile duct and duodenum,and a duodenoscope was introduced orally into the papilla of duodenum,the papilla of duodenum was dilated by the balloon which tracked along the guidewire,the stones of the common bile duct were removed with the reticulation and the duodenoscopis balloon,and then the gallbladder was resected. Results： The one-stage success of the procedure was achieved in 79 of the 80 patients（ 98. 75%）. The other one patient was converted to open surgery. The mean operative time was（ 95. 04 ± 13. 49） min. After the treatment,11 patients were diagnosed with hyperamylasemia. No cases had residual stones,perforation of intestine and bile duct,bile leakage,hemorrhage,severe pancreatitis or death. The mean postoperative hospital stay was（ 4. 82 ± 0. 76） d,and 79 patients were followed up for a mean of（ 9. 12 ± 2. 87） months,during which no abnormalities were detected by B-ultrasonography,all the patients showed normal liver function by laboratory examination. Conclusions： If patients are indicated,LC combined with EPBD is safe,effective and feasible for one-stage management of choledocholithiasis complicated with cholecystolithiasis. Its advantages include short hospital stay,preservation of Oddi sphincter function and few postoperative complications.