腹腔镜下气囊鼻胆管取石术、扩张术、引流术临床应用236例

On combination of laparoscopy,endoscopy,balloon nasobiliary cholelithotomy and dilatation and drainage for treatment of the cholecystolithiasis with thin choledochus stones: a report of 236 cases

目的 探讨腹腔镜、内镜联合气囊鼻胆管取石术、扩张术、引流术（LEBNE）同期治疗胆囊结石合并细径胆总管结石的临床疗效。方法 回顾性分析2010年4月至2015年8月运用LEBNE治疗236例胆囊结石合并细径胆总管（胆总管内径为0.2-0.8 cm）结石患者的临床资料。根据手术情况分为胆管镜组（52例）、十二指肠镜组（64例）和三镜组（120例）。采用SPSS19.0软件进行统计分析,组间术后成功率、并发症和鼻胆管引流情况计数资料采用χ^2检验。P〈0.05为差异有统计学意义。结果 胆管镜组行胆管镜取净结石31例（59.6%）。十二指肠镜组行乳头切开取净结石43例（67.2%）。三镜组经胆管镜、十二指肠镜联合取净结石99例（82.5%）。三镜组取净结石率明显高于其他2组,差异有统计学意义（χ^2=11.389,P〈0.05）。手术成功率比较,三镜组手术成功率（100%）均高于其他两组（十二指肠镜组89.0%,胆管镜组86.5%）差异有统计学意义（χ^2=14.255,P=0.000）。结论 只要病例选择合适,LEBNE同期治疗胆囊结石合并细径胆总管结石是可行、有效和安全的。

Objective To explore the clinical efficacy of balloon nasobiliary cholelithotomy and dilatation and drainage （ LEBNE ） on the treatment of cholecystolithiasis with thin choledochus stones. Methods The clinical data of 236 cases with choledochus stones and cbolecystolithiasis with small diameter （The internal diameter of common bile duct was 0.2 - 0.8 cm） who underwent LEBNE were analyzed retrospectively from April 2010 to August 2015 in the Second People, s Hospital of Chengdu. According to the operation methods, patients were divided into choledochoscope group （52 cases ） , duodenum mirror group （64 cases）, and three endoscopy group （120 cases）. SPSS19.0 software was used for statistical analysis. The rate of successful operation, the incidence of complications, and nasobiliary drainage were compared with chi square test. P 〈 0.05 was statistically significant. Results Sucessful removal of the bile duct residual stones through the choledochoscopy was achieved in 31 cases （59.6%）. The stones were removed with duodenoscopic papillotomy in 43 cases （67.2%）. The stones were removed in 99 cases （ 82.5% ） through the choledochoscopic and duodenoscopic procedure. The successful removal rate of the stones in the three endoscopy group was significantly high than those in the rest two other groups （χ^2 = 11. 389, P 〈 0.05 ）. The successful operation rate in the three endoscopy group was also significantly between these three groups with the three endoscopy group being the highest （Duodenum mirror group ,89.0% ;ccholedochoscope group 86.5% , χ^2 = 14. 255, P = 0. 000 ）. Conclusion LEBNE was safe and effective in treating cholecystolithiasis with thin choledochus stones among selected patients.