ERCP、EST联合LC治疗胆囊结石合并胆总管结石的临床分析

Clinical analysis of LC combined with ERCP and EST in the treatment of concomitant cholecystolithiasis and choledocholithiasis

目的:探讨内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)、内镜十二指肠乳头括约肌切开术(endoscopic sphincterotomy,EST)联合腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗胆囊结石合并胆总管结石的临床疗效。方法:回顾分析2009年7月至2013年7月为145例胆囊结石合并胆总管结石患者行ERCP+EST+LC/腹腔镜胆总管探查术的临床资料,其中138例LC术前发现合并胆总管结石,先行ERCP+EST,根据EST术后并发症治愈情况再行LC;LC术后发现胆总管残余结石7例,于LC术后1周行ERCP+EST治疗。结果:术前发现合并胆总管结石的138例患者中,129例LC术前取石成功,胆总管结石完全排出,成功率93.5%,ERCP+EST术后出现胰腺炎或高淀粉酶血症11例,胆管炎1例,消化道出血1例,治疗痊愈后行LC。另有9例ERCP插管不成功后行开腹胆囊切除+胆总管探查T管引流术。LC术后发现胆总管残余结石7例,ERCP+EST取石均成功,无并发症发生。结论:ERCP+EST联合LC治疗胆囊结石合并胆总管结石具有创伤小、效果好、并发症少、康复快等优点,扩大了LC的指征,符合外科手术微创化的趋势,可在临床推广应用。

Objective：To investigate the clinical value of endoscopic retrograde cholangiopancreatography （ERCP）, endoscopic sphincterotomy （EST） combined with laparoscopic cholecystectomy （LC） in the treatment of cholecystolithiasis and choledocholithia- sis. Methods：The clinical data of 145 patients who suffered from cholecystolithiasis and choledocholithiasis and underwent ERCP ＋ EST ＋ LC/laparoscopic common bile duct exploration from Jul. 2009 to Jul. 2013 were retrospectively studied. Among them, 138 patients with common bile duct stones （CBDS） were diagnosed before LC, firstly they were treated with ERCP ＋ EST, then LC was performed according to postoperative complications of EST ;7 were diagnosed after LC, ERCP ＋ EST treatment was performed for them one week af- ter LC. Results：Amomg the 138 patients with CBDS diagnosed before LC, 129 were successfully treated by ERCP ＋ EST （93.5%）, with CBDS completely discharged. Complications occurred in 13 cases （ 10.08% ）, including digestive tract bleeding （ n = 1 ）, cholangi- tis （ n = 1 ）, pancreatitis or hyperamylasemia （ n = 11 ）, they were treated with LC after complications were corrected. Open cholecystec- tomy ＋ common bile duct exploration ＋ T-tube drainage was performed in 9 patients whose ERCPs were failed. The ducts of the other 7 patients with CBDS were successfully cleared by postoperative ERCP ＋ EST. Conclusions ： ERCP ＋ EST combined with LC is shown to be safe, effective, minimally invasive ,with good clinical value ,few complications and fast recovery in the treatment of concomitant gall- stones and CBDS. This procedure expands the indications of LC, conforms to the trend of minimally invasive surgery, and can be popu- larized in clinical application.