胆囊结石合并胆总管结石现代外科治疗方式探析

Study on Modern Surgical Method for Cholecystolithiasis Combined with Choledocholithiasis

胆石症在消化外科发生率较高,我国发病率约为7%-10%。胆石症以胆囊结石为主,部分可合并胆总管结石。胆石症的既往主要治疗方式是开腹胆囊切除+胆总管探查+T管引流术(OC+OCH+TD)。但近年来随着微创外科的不断发展,其治疗模式已有长足的进步。我国目前用于治疗胆石症尤其是胆囊结石合并胆总管内结石的微创治疗模式包括2种:阶梯治疗方案:内镜逆行胰胆管造影(ERCP)/内镜下括约肌切开取石术(EST)+二期腹腔镜胆囊切除术(LC),即ERCP/EST+LC;同期治疗方案:LC+腹腔镜胆总管探查术(LCBDE),即LC+LCBDE。本文通过探析两种治疗方案的适应症、禁忌症和并发症,为临床在胆囊结石合并胆总管结石治疗方法的选择上提供依据。

Incidence of cholelithiasis is higher in digestive surgery, and its incidence is 7%-10% in China. Cholelithiasis is mainly about cholecystolithiasis, partually combined with choledocholithiasis. Open cholecystectomy combined with open choledocholithotomy plus T-tube drainage （OC＋OCH＋TD） is the normal therapy for cholelithiasis. But in recent years, with the development of minimally invasive surgery, its treatment method has progressed significantly.There are two minimally invasive treatment methods for cholelithiasis, especially for cholecystolithiasis and choledocholithiasis, at present in China： Ladder therapy： endoscopic retrograde cholangiopancreatography（ERCP）/endoscopic sphincterotomy（EST） plus laparoscopic cholecystectomy（LC）（ERCP/EST plus LC）; Simultaneous therapy： LC plus laparoscopie common bile duct exploration （LCBDE）（ LC plus LCBDE）. This article will provide the optimal choice in the treatment of cholecystolithiasis combined with choledocholithiasis for the clinicians through discussing the indications, contraindications and complications of the two kinds of therapy.