BACKGROUND: Clinical application of laparoscopy, duo- denoscopy and choledochoscopy has been accepted as a mini-invasive surgical therapy for bile duct diseases; but ei- ther endoscopic or laparoscopic therapy alone i...BACKGROUND: Clinical application of laparoscopy, duo- denoscopy and choledochoscopy has been accepted as a mini-invasive surgical therapy for bile duct diseases; but ei- ther endoscopic or laparoscopic therapy alone is disadvanta- geous in its narrow indications and in failure to give full play to the individual superiority. The present study was to evaluate the procedures and therapeutic results of combined laparoscopic and endoscopic treatment for bile duct disea- ses. METHODS: Clinical data of 1990 patients with bile duct diseases treated by combination of laparoscopy, duodenos- copy and choledochoscopy in two hospitals were reviewed and analyzed. RESULTS: Patients with cholecystolithiasis and choledo- cholithiasis were treated with combined laparoscopy and duodenoscopy (n =1350) in a single operation with a cure rate of 93.6%. Those with choledocholithiasis (n =332) were treated with combined laparoscopy and choledocho- scopy with a cure rate of 100%. Combined laparoscopy, duo- denoscopy and choledochoscopy was used in 258 patients with choledocholithiasis (29 of them complicated with pan- creatitis) and 24 patients with Mirizzi's syndrome, with a cure rate of 100%. Laparoscopic choledochoenterostomy and preoperative endoscopic nasobiliary drainage were done in 26 patients with a cure rate of 100%. There were no serious operative complications. A follow-up study of 1051 patients for 3 months to 12 years (mean 7.8 years) showed that 10 patients had recurrence of stones but no stenosis of the bile duct. CONCLUSION: Combined laparoscopic and endoscopic procedures are mini-invasive and cause less pain and mini- mal operative complications.展开更多
肝内外胆管结石是一种常见、多发疾病,其传统的开腹手术近年来受到微创手术的挑战.本文通过文献检索,结合作者的实践经验,在全面总结肝内、外胆管结石的微创治疗现状基础上,探讨出一种可有效提高其微创治疗效果的策略:(1)对于肝内胆管结...肝内外胆管结石是一种常见、多发疾病,其传统的开腹手术近年来受到微创手术的挑战.本文通过文献检索,结合作者的实践经验,在全面总结肝内、外胆管结石的微创治疗现状基础上,探讨出一种可有效提高其微创治疗效果的策略:(1)对于肝内胆管结石:可根据指征选用腹腔镜肝切除、腹腔镜胆总管探查取石术(laparoscopic common bile duct exploration,LCBDE)、经皮经肝胆道镜取石术;(2)对于胆囊结石合并胆总管结石:可根据指征选用腹腔镜胆囊切除(laparoscopic cholecystectomy,LC)+经内镜十二指肠乳头括约肌切开(endoscopic sphincterotomy,EST)或经内镜乳头气囊扩张术(endoscopic papillary balloon dilatation,E P B D)、L C+经胆囊管胆总管探查取石术(laparoscopic transcystic common bile duct exploration,LTCBDE)、LC+LCBDE+T管引流或一期缝合术;(3)对于肝内合并肝外胆管结石,可根据指征选用腹腔镜肝切除、经肝断面胆管胆道镜取石、LCBDE、EST、经皮经肝胆道镜碎石术.根据上述策略,结合术者的技术和设备条件,合理选择微创治疗方法,对于提高肝内、外胆管结石的治疗效果具有重要意义.展开更多
目的:探讨应用"三镜"联合治疗胆囊结石并胆道结石的疗效。方法:回顾分析2005年1月至2009年12月治疗101例胆囊结石并胆总管结石患者的临床资料,其中行内镜下乳头括约肌切开术(endoscopic sphincterotomy,EST)+腹腔镜胆囊切除术...目的:探讨应用"三镜"联合治疗胆囊结石并胆道结石的疗效。方法:回顾分析2005年1月至2009年12月治疗101例胆囊结石并胆总管结石患者的临床资料,其中行内镜下乳头括约肌切开术(endoscopic sphincterotomy,EST)+腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)25例,LC+腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)23例,53例行LC+EST+LCBDE,并对比分析3组患者胆总管内径、结石大小、手术时间、治疗费用、并发症发生率、术后住院时间、手术成功率等。结果:"三镜"联合与其他两种方法相比,并发症发生率低,手术时间和住院时间亦不延长。结论:"三镜"联合是目前治疗胆囊结石并胆总管结石的较好选择,是安全可靠、疗效确切的微创治疗方案,值得推广。展开更多
目的:探讨腹腔镜技术下胆囊结石合并胆总管结石微创治疗策略的合理选择。方法:总结为76例胆囊结石合并胆总管结石患者采用腹腔镜联合胆道镜、十二指肠镜等不同组合的微创手术治疗经验。结果:37例患者于腹腔镜胆囊切除术(laparoscopic ch...目的:探讨腹腔镜技术下胆囊结石合并胆总管结石微创治疗策略的合理选择。方法:总结为76例胆囊结石合并胆总管结石患者采用腹腔镜联合胆道镜、十二指肠镜等不同组合的微创手术治疗经验。结果:37例患者于腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)前行内镜下十二指肠乳头括约肌切开取石术(endoscopic sphincterotomy,EST),其中26例取石成功,11例改行腹腔镜胆总管探查取石术(laparoscopic common bile duct exploration,LCBDE),2例因胆囊炎症重中转开腹。39例患者行LC+LCBDE,其中29例取石成功(6例联合胆道镜下钬激光碎石),6例中转开腹,3例因取石困难术后行EST取石。LCBDE术后发生胆漏3例,腹腔引流8 d痊愈;术后2例T管引流胆道出血,经保守治疗1周内好转。EST术后5例发生黑便,2例血淀粉酶一过性升高,均经保守治疗1周内好转。平均住院(9.4±7.4)d,术后无严重并发症发生。结论:术者应结合个人经验、技术水平及患者病情合理选择微创治疗手段,Oddi括约肌功能完好的患者,LC+LCBDE更能体现微创的真正内涵。展开更多
文摘BACKGROUND: Clinical application of laparoscopy, duo- denoscopy and choledochoscopy has been accepted as a mini-invasive surgical therapy for bile duct diseases; but ei- ther endoscopic or laparoscopic therapy alone is disadvanta- geous in its narrow indications and in failure to give full play to the individual superiority. The present study was to evaluate the procedures and therapeutic results of combined laparoscopic and endoscopic treatment for bile duct disea- ses. METHODS: Clinical data of 1990 patients with bile duct diseases treated by combination of laparoscopy, duodenos- copy and choledochoscopy in two hospitals were reviewed and analyzed. RESULTS: Patients with cholecystolithiasis and choledo- cholithiasis were treated with combined laparoscopy and duodenoscopy (n =1350) in a single operation with a cure rate of 93.6%. Those with choledocholithiasis (n =332) were treated with combined laparoscopy and choledocho- scopy with a cure rate of 100%. Combined laparoscopy, duo- denoscopy and choledochoscopy was used in 258 patients with choledocholithiasis (29 of them complicated with pan- creatitis) and 24 patients with Mirizzi's syndrome, with a cure rate of 100%. Laparoscopic choledochoenterostomy and preoperative endoscopic nasobiliary drainage were done in 26 patients with a cure rate of 100%. There were no serious operative complications. A follow-up study of 1051 patients for 3 months to 12 years (mean 7.8 years) showed that 10 patients had recurrence of stones but no stenosis of the bile duct. CONCLUSION: Combined laparoscopic and endoscopic procedures are mini-invasive and cause less pain and mini- mal operative complications.
文摘肝内外胆管结石是一种常见、多发疾病,其传统的开腹手术近年来受到微创手术的挑战.本文通过文献检索,结合作者的实践经验,在全面总结肝内、外胆管结石的微创治疗现状基础上,探讨出一种可有效提高其微创治疗效果的策略:(1)对于肝内胆管结石:可根据指征选用腹腔镜肝切除、腹腔镜胆总管探查取石术(laparoscopic common bile duct exploration,LCBDE)、经皮经肝胆道镜取石术;(2)对于胆囊结石合并胆总管结石:可根据指征选用腹腔镜胆囊切除(laparoscopic cholecystectomy,LC)+经内镜十二指肠乳头括约肌切开(endoscopic sphincterotomy,EST)或经内镜乳头气囊扩张术(endoscopic papillary balloon dilatation,E P B D)、L C+经胆囊管胆总管探查取石术(laparoscopic transcystic common bile duct exploration,LTCBDE)、LC+LCBDE+T管引流或一期缝合术;(3)对于肝内合并肝外胆管结石,可根据指征选用腹腔镜肝切除、经肝断面胆管胆道镜取石、LCBDE、EST、经皮经肝胆道镜碎石术.根据上述策略,结合术者的技术和设备条件,合理选择微创治疗方法,对于提高肝内、外胆管结石的治疗效果具有重要意义.
文摘目的:探讨应用"三镜"联合治疗胆囊结石并胆道结石的疗效。方法:回顾分析2005年1月至2009年12月治疗101例胆囊结石并胆总管结石患者的临床资料,其中行内镜下乳头括约肌切开术(endoscopic sphincterotomy,EST)+腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)25例,LC+腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)23例,53例行LC+EST+LCBDE,并对比分析3组患者胆总管内径、结石大小、手术时间、治疗费用、并发症发生率、术后住院时间、手术成功率等。结果:"三镜"联合与其他两种方法相比,并发症发生率低,手术时间和住院时间亦不延长。结论:"三镜"联合是目前治疗胆囊结石并胆总管结石的较好选择,是安全可靠、疗效确切的微创治疗方案,值得推广。
文摘目的:探讨腹腔镜技术下胆囊结石合并胆总管结石微创治疗策略的合理选择。方法:总结为76例胆囊结石合并胆总管结石患者采用腹腔镜联合胆道镜、十二指肠镜等不同组合的微创手术治疗经验。结果:37例患者于腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)前行内镜下十二指肠乳头括约肌切开取石术(endoscopic sphincterotomy,EST),其中26例取石成功,11例改行腹腔镜胆总管探查取石术(laparoscopic common bile duct exploration,LCBDE),2例因胆囊炎症重中转开腹。39例患者行LC+LCBDE,其中29例取石成功(6例联合胆道镜下钬激光碎石),6例中转开腹,3例因取石困难术后行EST取石。LCBDE术后发生胆漏3例,腹腔引流8 d痊愈;术后2例T管引流胆道出血,经保守治疗1周内好转。EST术后5例发生黑便,2例血淀粉酶一过性升高,均经保守治疗1周内好转。平均住院(9.4±7.4)d,术后无严重并发症发生。结论:术者应结合个人经验、技术水平及患者病情合理选择微创治疗手段,Oddi括约肌功能完好的患者,LC+LCBDE更能体现微创的真正内涵。
