腹腔镜联合术中胆管造影、括约肌切开术序贯诊治胆结石病106例

Laparoscopic cholecystectomy combined with intraoperative cholangiography and endoscopic sphincterotomy for the treatment of choledocholithiasis

目的探讨腹腔镜胆囊切除术 (laparoscopiccholecystectomy ,LC)联合术中胆管造影(intraoperativecholangiography ,IOC)、术中括约肌切开术 (intraoperativeendoscopicsphincterotomy ,IOEST)序贯诊治胆结石病的价值。方法回顾分析序贯诊治 10 6例胆结石病的临床效果。结果6 4例 (6 0 4 % ,6 4 /10 6 )术前诊断胆囊结石 ,经IOC发现有胆总管结石 ;序贯治疗手术成功率为 93 4 %(99/10 6 ) ,98例胆总管结石被取净。术后并发症 :水肿型急性胰腺炎 6例 (6 1% )、十二指肠穿孔 1例(0 9% ,1/10 6 )、胆漏 1例 (0 9% ,1/10 6 )、气胸 1例 (0 9% ,1/10 6 )、漏诊十二指肠乳头癌 1例(0 9% ,1/10 6 )、胃潴留 2例 (1 8% ,2 /10 6 )。术后平均住院时间 3 7d。结论LC联合IOC、IOEST能一次性微创诊治胆囊结石合并胆总管结石。

ObjectiveTo evaluate the effect of laparoscopic cholecystectomy (LC) combined with intraoperative cholangiography (IOC) and intraoperative endoscopic sphincterotomy (IOEST) for the diagnosis and treatment of choledocolithiasis. Methods Statistical analysis was carried out for 106 patients with cholecystocholedocolithiasis diagnosed and treated by LC-IOC-IOEST. Results Sixty-four (60.4%, 64/106 ) patients with preoperative diagnosis of simple gall stone were found with complicated choledocholithisis; LC-IOC -IOEST was successfully performed in 99(93.4%, 99/106) cases. Six cases (6.1%) suffered from mild postoperative acute pancreatitis. Duodenal perforation, bile leakage, peumothorax (0.9%) developed in one each. Duodenal adenocarcinoma was overlooked in one case, and 2 cases (1.8%) suffered from gastric paralysis. Conclusion LC combined with IOC and IOEST was a safe, effective approach to the diagnosis and minimally invasive treatment of choledocholithiasis.