腹腔镜联合十二指肠镜治疗胆囊结石合并胆总管结石的诊治体会

Laparoscopic cholecystectomy combined with endoscopic sphincterotomy for management of choledocholithiasis:an experience report

目的探讨腹腔镜胆囊切除术联合十二指肠镜乳头括约肌切开术治疗胆囊结石合并胆总管结石的手术疗效。方法共收集45例胆囊结石合并胆总管结石患者行不同手术方式的病例资料,其中行十二指肠镜下乳头括约肌切开联合腹腔镜胆囊切除术者(EST+LC组)共20例,行腹腔镜胆囊切除+胆总管切开取石+T管引流术者(OC+OCHTD组)共25例。对两种术式患者的手术成功率、术后并发症发生率以及住院时间等指标进行统计学分析。结果所有患者均获得2~6月随访。EST+LC组中,18例手术完成,2例因局部粘连或技术原因插管困难,转为开放手术;手后并发症包括2例轻度胰腺炎,1例十二指肠乳头出血,均经过保守后痊愈。OC+OCHTD组中,5例出现手术并发症,包括1例胆漏、2例切口感染、2例腹部感染,经保守治疗痊愈。EST+LC组患者住院时间较OC+OCHTD组明显缩短。结论至少在短期内,内镜十二指肠括约肌切开联合腹腔镜胆囊切除术治疗胆囊结石合并胆总管结石是一种安全、有效、可行的微创治疗方法。

Objective To summarize up the experience in management of choledocholithiasis by laparoscopic cholecystectomy combined with endoscopic sphincterotomy. Methods A retrospective data of medical records for 20 patients with common bile duct stones undergoing laparoscopic cholecystectomy combined with endoscopic sphincterotomy between Jun 2014 and Aug 2016 was undertaken and served as treatment group（EST＋LC）. Another 25 patients in the same term who underwent open surgical cholecystectomy and T-tube drainage（OC＋OCHTD）was selected as control group. The operative outcomes,procedure-related complications were compared between two groups. Results The patients in two group were followed up for 2 to 6 months. In EST＋LC group,18 cases completed smoothly,and two cases transferred to open operation due to difficult intubation. The complications occurred in three cases,two cases of acute pancreatitis and one case of duodenal papilla bleeding. In OC＋OCHTD group,five cases complicated with incision infection（2 cases）,bile leakage（one case）,and pulmonary infection（2 cases）. All patients in two groups got recovery by conservation treatment. Conclusion Our outcomes showed that at least in the short term,endoscopic sphincterotomy combined with laparoscopic cholecystectomy was a safe,effective and feasible method for the treatment of cholecystolithiasis and choledocholithiasis.