医联体模式下行ERCP和EST联合LC治疗胆囊结石合并胆总管结石的临床体会

The experience of ERCP and EST combinedwith LC in the treatment of cholecystolithiasis and choledocholithiasis under the regional medical consortium mode

目的探讨医联体模式下联合治疗胆囊结石合并胆总管结石的诊疗方案。方法对2013年1月～2016年12月苏州市相城区第三人民医院和苏州市立医院联合收治,由苏州市立医院行ERCP+EST的胆囊结石合并胆总管结石患者进行回顾性分析,对其术中以及术后诊疗进行综合分析。结果 27例患者中,20例(74.07%)患者顺利进行医联体模式下的ERCP+EST联合LC治疗胆囊结石合并胆总管结石的手术,且均取得良好的治疗效果。两次手术间隔时间2～7天,LC手术时间30～95分钟,总住院天数9～16天。无中转开腹,无胆管损伤等严重并发症的发生。结论医联体模式下行内镜逆行胰胆管造影(ERCP)、内镜十二指肠乳头肌切口术(EST)联合腹腔镜胆囊切除术(LC)治疗胆囊结石合并胆总管结石在高龄患者、有较严重合并症的患者、不能耐受长时间麻醉手术的患者是可行的。

Objective To explore the diagnosis and treatment plan of combined treatment of cholecystolithiasis and choledocholithiasis under the regional medical consortium mode. Methods From January 2013 to December 2016, the patients with cholecystolithiasis complicated with choledo- cholithiasis treated by ERCP ＋ EST in Suzhou Xiaaagcheng Third People＇ s Hospital and Suzhou State Hospital were retrospectively analyzed. The in- traoperative and postoperative diagnosis and treatment were analyzed. Results Of the 27 patients, 20 （74.07%） successfully underwent ERCP ＋ EST combined with LC under the combined modality for cholecystolithiasis with choledocholithiasis, and achieved good results. The interval between the two operations was 2-7 days, the LC operation time was 30-95 min, and the total length of stay was 9-16 days. No conversion to open surgery, no bile duct injury and other serious complications. Conclusion In the regional medical consortium mode, endoscopic retrograde cholangiopancreatography （ERCP）, endoscopic duodenal papillary myotomy （EST） combined with laparoscopic cholecystectomy （LC） for cholecystolithiasis with common bile duct stones in elderly patients, patients with more serious complications, patients who can not tolerate long-term anesthesia surgery are Feasible.