三镜联合体内冲击波碎石仪治疗嵌顿性胆管结石

Combination of three kinds of endoscopies in shock-wave lithotripsy forincarcerated bile ductcalculi

目的探讨三镜（腹腔镜、胆道镜、十二指肠镜）联合体内冲击波碎石仪治疗嵌顿性胆管结石的临床疗效。方法对51例嵌顿性胆管结石患者，采用三镜联合体内冲击波碎石仪治疗。结果48例成功完成腹腔镜手术，3例中转开腹，胆总管、左右肝管的嵌顿结石全部被清除，其中7例行胆总管一期缝合，10例行内镜下十二指肠乳头括约肌切开术（EST）＋T管引流术。手术时间95—180min，平均（118±14）min；术中出血25～130ml，平均（58±11）ml。术后第1天均可下床活动，胃肠功能恢复时间平均（2±1）天。术后住院3—10天，平均（7±2）天。发生胆漏2例，轻型胰腺炎3例，经保守治疗治愈。术后随访6个月～2．5年，未发现胆管狭窄等严重并发症。结论腹腔镜、胆道镜、十二指肠镜联合应用体内冲击波碎石治疗嵌顿性胆管结石疗效确切，且创伤小、恢复快、安全性高，具有较好的推广价值。

Objective To explore the therapeutic effects of shock-wave lithotripsy tor incarcerat- edbile duct calculi via laparoscopy, choledochoscopy, and duodenoscopy. Methods The clinical data of 51 patients who suffered from incarcerated bile duct calculi and underwent three kinds of endoscopies were retrospectively reviewed from May 2012 to July 2015. Results Laparoscopic operation was successfully performed for 48 patients,while 3 patients was converted to laparotomy. All impacted bile calculi of common bile duct and both hepatic ducts were removed completely, among whom there were 7 patients were performed the first phase suture of common bile duct and 10 patients were performed EST plus drainage of T-tube. The mean operative time was （118 ± 14）min （ range, 95 - 180 min）. The mean blood loss was （58 ±11 ）ml（ range,25 ± 130 ml）. Ambulation was on the first postoperative day. The mean time of post- operative gastrointestinal function recovery was（2 ± 1 ）d. The mean postoperative hospital stay was（7 ± 2） d（ range,3 ± 10 d）. Two cases of unexpected biliary fistula and three cases of acute edematous pancreati- tis happened,all of them were solved without operation. All patients were followed up for 6 months-2.5 years, and during that period no serious Complications such as stenosis of bile duct occurred. Conclusion Shock-wave lithotripsy in vivo combined with laparoscopy, choledochoscopy, andduodenoscopy is effectivefor incarcerated bile ductcalculi, which has the advantages of less trauma, rapid recovery and high safety. This technique should be extended by laparoscopic experts.