腹腔镜胆囊切除结合内镜Oddi’s括约肌切开取石二期治疗胆道结石

Two-stage laparoscopic cholecystectomy and endoscopic sphincterotomy for mangement of patients with cholecystocholedocholithiasis

目的 :探讨联合应用腹腔镜胆囊切除术 (laparoscopiccholecystectomy,LC)和内镜Oddi’s括约肌切开术 (endoscopicsphincterotomy ,EST) +内镜下胆总管取石二期治疗胆囊和胆管结石病的方法和价值。方法 :对12例胆囊和胆总管结石病病人 (术前经MRCP或B超证实 ) ,在全麻下一期行LC术后 1w ,二期行ERCP +EST+内镜下胆总管取石以清除残余胆管结石。结果 :12例病人LC和EST均在 2w内顺利完成 ,术中和术后无严重并发症发生 ,术后 10～ 15d出院。结论 :联合应用LC和EST +内镜下胆总管取石分期治疗胆囊和胆管结石病切实可行 ,该法具有手术成功率高、病人痛苦少和住院时间短的优点。

Objective:To evaluate the effect of combined laparoscopic cholecystectomy(LC) and endoscopic sphincterotomy(EST) for a two-session treatment of patients with cholecystocholedocholithiasis.Methods:12 cases with cholecystocholedocholithiasis underwent LC and EST as a combined procedure under general anesthesia. All of the 12 cases were preoperatively diagnosed as having concommitant gall stones and cholelithiasis by MRCP or BUS.Results:The procedures were successfully accomplished in all patients. No severe complications of EST or LC were observed. The range of total hospital staying was 7～15 days.Conclusion:The two-stage of LC and EST is the therapy of choice for cholecystocholedocholithiasis patients,which preserving the minimally invasive appoach and has the merit of high successful rate,less injury and short hospital staying.