腹腔镜、十二指肠镜联合术中超声经胆囊管顺行插管治疗胆囊结石合并细径胆总管结石34例

Clinical effect of laparoscopic forward intubation through the cystic duct during laparoscope,duodenoscope and intraoperative ultrasound to treat 34 cases of cholecystolithiasis and thining choledocholithiasis

目的探讨腹腔镜胆囊切除、经胆囊管顺行导丝插管联合十二指肠镜、术中超声一期治疗胆囊结石合并细径胆总管结石的临床效果。方法收集本院2019年6月~2020年8月胆囊结石合并细径胆总管结石108例。研究组34例,行腹腔镜、十二指肠镜联合术中超声经胆囊管顺行插管治疗胆囊结石合并细径胆总管结石;对照组74例,行经内镜逆行胰胆管造影(ERCP)+腹腔镜胆囊切除术(LC)治疗胆囊结石合并细径胆总管结石,比较两种方法的治疗效果。结果两组病人均成功完成腹腔镜下胆囊切除术。研究组病人均顺利经胆囊管顺行插管至十二指肠乳头。对照组中3例ERCP治疗失败,改为经胆囊管顺行导丝插管联合十二指肠镜、术中超声一期治疗成功。对照组8例病人出现轻度胰腺炎症状,研究组0例。对照组3例结石残留,研究组1例。对照组有1例十二指肠小穿孔,手术治疗好转。108例病人均获得随访,随访时间2~14个月,中位随访时间7个月。无结石复发,无死亡。结论腹腔镜胆囊切除、经胆囊管顺行导丝插管联合十二指肠镜、术中超声一期治疗胆囊结石合并细径胆总管结石安全有效可行。

Objective To investigate the clinical effect of laparoscopic chole-cystectomy(LC),laparoscopic forward intubation through cystic duct combined with duodenoscope and intraoperative ultrasound in the one-stage treatment of cholecysto-lithiasis and thining choledocholithiasis.Methods Retrospective cohort study was performed to analyze the clinical data of 108 cases of cholecystolithiasis complicated with thining choledocholithiasis from June 2019 to August 2020.The 34 patients who underwent laparoscopic intubation through the the cystic duct duct during laparoscope,duodenoscope and intraoperative ultrasound were allocated into the study group,and the remaining 74 patients received treatment by laparoscope combined with duodenoscope were assigned to the control group.Results Both groups underwent laparoscopic cholecystectomy successfully.The intubated was successfully inserted via cystic duct into the duodenal papilla.Eight patients in the control group were failed to ERCP treatment.Instead,they were successfully treated with the study group treatment.Seven patients in the control group developed mild pancreatitis,while no pancreatitis was found in the study group.In the control group,3 cases possessed residual stones and the study group had 1 case.There was 1 case of duodenal perforation in the control group,and which was improved through surgical treatment.All 108 patients were followed up for 2-14 months,with a median follow up time of 7 months.No stone recurrence or death occurred.Conclusion Laparoscopic cholecystectomy,laparoscopic forward intubation through cystic duct combined with duodenoscope and intraoperative ultrasound for the one-stage treatment of cholecystolithiasis and thining choledocholithiasis are safe,effective and feasible.