胆囊结石合并胆总管结石微创治疗分析

目的探讨腹腔镜联合胆道镜或内镜TOddi括约肌切开取石术（EST）治疗胆囊结石合并胆总管结石治疗的临床价值。方法2014年1月至2016年12月对86例胆囊结石合并胆总管结石患者分别行腹腔镜胆囊切除、胆总管切开取石；内镜下Oddi括约肌切开取石。二期行腹腔镜胆囊切除。结果40例均完成腹腔镜联合胆道镜探查取石，1例发生胆漏，保持腹腔引流10d后痊愈出院，随访2个月无并发症；46例先行经内镜逆行性胰胆管造影术（ERCP），内镜下Oddi括约肌切开取石，再行腹腔镜胆囊切除，1例发生Oddi括约肌切开处出血，行十二指肠镜下施夹止血成功。结论腹腔镜联合胆道镜行胆囊切除、胆总管切开取石，EST后再行腹腔镜胆囊切除治疗，胆囊结石合并胆总管结石均有满意疗效。

Objective To analyze the clinical effects of the laparoscopic joint choledochoscope or endoscopic sphincterotomy （ EST ） in the treatment of cholecystolithiasis combined with choledocholithiasis. Methods 86 patients from January 2014 to December 2014 with gallbladder stone with common bile duct stones were separately underwent laparoscopic cholecystectomy plus common bile duct exploration endoscopic sphincterotomy to remove stone, second line laparoscopic cholecystectomy. Results 40 cases were underwent laparoscopic joint choledochoscope to remove the stones, biliary leakage occurred in 1 case and recovered after the treatment of abdominal cavity drainage l0 days. No complications were followed up for 2 month. 46 cases were underwent endoscopic retrograde pancreatic angiography （ ERCP ） plus endoscopic sphincterotomy to remove stone, then laparoscopic cholecystectomy.Bleeding occurred in 1 case of endoscopic sphincterotomy. Conclusion Laparoscopic cholecystectomy combined with choledochoscopy, common bile duct lithotomy, laparoscopic cholecystectomy after EST treatment, cholecystolithiasis and choledocholithiasis have satisfactory curative effect.