三镜联合治疗胆囊结石合并胆总管结石

Experience of Combined Use of Laparoscope,Choledochoscope or Duodenoscope for Cholecystolithiasis With Choledocholithiasis

目的探讨三镜联合治疗胆囊结石合并胆总管结石的效果。方法回顾性分析2009年1月~2015年5月三镜联合治疗胆囊结石合并胆总管结石75例的临床资料。38例行十二指肠镜联合腹腔镜手术,37例行腹腔镜联合胆道镜手术。结果 38例十二指肠镜联合腹腔镜治疗中,34例乳头括约肌切开(endoscopic sphincterotomy,EST)或球囊扩张(endoscopic papillary balloon dilatation,EPBD)取石成功,术后3~5天行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC),其中1例中转开腹;3例EST取石失败,行内镜鼻胆管引流(endoscopic nasobilliary drainage,ENBD),术后3~7天行腹腔镜联合胆道镜手术;1例因结石嵌顿于十二指肠大乳头中转开腹手术。40例腹腔镜联合胆道镜治疗(包括3例EST取石失败行ENBD者)中,38例手术成功,其中5例胆总管一期缝合,33例T管引流,术后胆漏2例,胆总管残余结石3例;2例中转开腹。71例随访1~3年,平均1.5年,无胆总管狭窄,1例结石复发。结论三镜联合治疗胆囊结石合并胆总管结石安全有效,能够在基层医院推广。

Objective To investigate the effect of combined use of laparoscope, choledochoscope or duodenoscope for cholecystolithiasis with choledocholithiasis. Methods A retrospective analysis was made on clinical data of 75 cases of cholecystolithiasis with choledocholithiasis receiving combined treatment with laparoscope, choledochoscope or duodenoscope from January 2009 to May 2015. There were 38 cases receiving duodenoscopy combined with laparoscopic surgery and 37 cases receiving laparoscopic surgery combined with choledochoscopy. Results Among 38 cases of duodenoscopy combined with laparoscopy, 34 cases had stones extraction by endoscopic sphincterotomy （EST） or endoscopic papillary balloon dilatation （EPBD）. Laparoscopic cholecystectomy （LC） was performed on the 3-5 days after the operations, including 1 case converted to laparotomy. EST was failed in 3 cases which were given endoscopic nasobilliary drainage （ENBD）, and laparoscopy combined with choledochoscopy was given on the 3-7 days after the operations. Conversion to laparotomy was performed in 1 case due to stone incarceration in the duodenal great papilla. Among 40 cases of laparoscopy combined with choledochoscopy （including 3 cases of failed EST receiving ENBD）, 38 cases were successfully operated, including 5 cases of primary suture of the common bile duct and 33 cases of T-tube drainage. There were 2 cases of postoperative bile leakage and 3 cases of residual choledocholithiasis. Two cases were converted to laparotomy. A total of 71 cases were followed up for 1-3 years （mean, 1.5 years）. No common bile duct stenosis occurred. Recurrence of the stone was found in 1 case. Conclusion It is safe and effective to treat cholecystolithiasis with choledocholithiasis by using laparoscope, choledochoscope or duodenoscope combined, which can be popularized in grass-roots hospitals.