改进法二镜联合治疗胆总管结石合并胆囊结石

Improved methods of combined duodenoscope and laparoscope in the treatment of choledocholithiasis complicated with cholecystolithiasis

目的 探讨胃肠减压、胆囊切除的步骤、胆总管分离、切开胆总管、胆总管取石、减少胆汁污染的腹腔改进法二镜联合治疗胆总管结石合并胆囊结石手术的优点。方法 回顾性分析福建医科大学附属闽东医院2013年12月-2015年12月完成的40例改进法二镜联合治疗胆总管结石合并胆囊结石的临床资料。结果 40例患者均顺利完成手术,平均手术时间（110.1±35.8）min,其中取石时间（50.2±15.6）min,一般24-36 h患者胃肠道功能均能恢复。术后少量胆漏4例,经引流后治愈;2例造影提示残余结石,6周经T管窦道取尽结石;肺部感染3例保守治疗后痊愈,所有患者均治愈出院。结论 改进法二镜联合治疗胆总管结石合并胆囊结石可提高取石效率,缩短手术时间,减少手术并发症,充分体现微创的理念。

Objective To discuss the advantages of abdominal improved methods of combined duodenoscope and laparoscope in the treatment of choledocbolithiasis complicated with cholecystolithiasis, including gastrointestinal decompression, procedures of cholecysteetomy, separation of common bile duct, section of common bile duct, choledocholithotomy and reduction of bile contamination. Methods All clinical data of 40 cases who were given improved methods of combined duodenoscope and laparoscope in the treatment of choledocholithiasis complicated with cholecystolithiasis in Affiliated Mindong Hospital of Fujian Medical University from December 2013 to December 2015 were retrospectively analyzed. Results The surgery was completed successfully in 40 patients. The surgery time was （110.1±35.8） min, and the duration of removing calculus was （50.2±15.6） min. Patients＇ gastrointestinal functions were recovered within 24- 46 hours. Small amount of bile leakage was shown in 4 patients after surgery, and was cured by drainage. Residual calculus was observed in 2 patients by radiography, and the calculus was completely removed by T-tube sinus tract in 6 weeks. Pulmonary infection was seen in 3 patients, and cured by conservative therapy. All patients were cured and discharged from the hospital. Conclusion Improved methods of combined duodenoseope and laparoscope in the treatment of eholedocholithiasis complicated with choleeystolithiasis is able to improve the efficiency of removing calculus, shorten surgery time, and reduce surgery-induced complications, which fully manifests the concept of minimally invasire surgery.