十二指肠镜联合腹腔镜治疗胆囊结石合并胆总管结石

Duodenoscopy combined with laparoscopy for one-stage management of cholecystolithiasis complicated with choledocholithiasis

目的:探讨内镜十二指肠乳头括约肌切开术(endoscopic sphincterotomy,EST)或内镜十二指肠乳头球囊扩张术(endoscopic papillary balloon dilatation,EPBD)联合腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)同期治疗胆囊结石合并胆总管结石的可行性。方法:2014年1月至2015年12月为75例胆总管结石合并胆囊结石患者行EST或EPBD取石成功后改全麻下行三孔法LC。结果:71例成功施行EST或EPBD联合LC同期手术,成功率94.7%。2例患者EST成功后因胆囊与周围组织形成致密粘连中转开腹行胆囊切除术;2例患者EST取石未成功改LC+胆总管切开胆道镜取石T管引流术。术后2例患者出现急性胰腺炎,2例患者出现十二指肠乳头出血,均经保守治疗后痊愈;2例患者术后鼻胆管造影发现残余结石,经二次取石后痊愈出院。术后平均随访(13.25±3.45)个月,行腹部彩超及肝功能检查未见明显异常。结论:在严格把握手术指征的基础上,EST或EPBD联合LC同期治疗胆囊结石合并胆总管结石可显著减少患者住院次数、缩短住院时间、降低住院费用,是安全、可行的。

Objective：To study the feasibility of one-stage management with endoscopic sphincterotomy （EST） or endoscopic papillary balloon dilatation （EPBD） plus laparoscopic cholecystectomy （LC） for cholecystolithiasis complicated with choledocholithiasis. Methods： Seventy-five patients with choledocholithiasis complicated with cholecystolithiasis, who underwent EST or EPBD combined with LC from Jan. 2014 to Dec. 2015, were enrolled into this retrospective analysis. In all the patients,three-port LC was carried out under general anesthesia after stones were removed by EST or EPBD. Results：The one-session success of the procedure was achieved in 71 of the 75 patients （94.7%）. Two patients were converted to open surgery because of the gallbladder adhesion. The other two patients were converted to LC, choledocholithotomy and T tube drainage because of failure in EST. After the treatment, two patients developed acute pancreatitis, and two patients developed papillary bleeding, all of them recovered after conservative treatment. Two patients had residual stones and therefore underwent a second operation,which cured all of them. The patients were followed up for a mean of （ 13.25 ± 3.45 ） months, during which no abnormalities were detected by B-ultrasonography, all the patients showed normal liver function by laboratory examination. Conclusions ： EST or EPBD combined with LC is safe and feasible for one-stage management of choledocholithiasis complicated with cholecystolithiasis, this procedure can significantly decrease times and cost of hospitalization, and hospital stay for selected patients.