腹腔镜联合十二指肠镜治疗胆囊结石合并胆总管结石

目的:探讨腹腔镜联合十二指肠镜治疗胆囊结石合并胆总管结石的临床疗效.方法:回顾分析2009年1月-2010年12月腹腔镜胆囊切除术(LC)联合十二指肠镜治疗35例胆囊结石合并胆总管结石患者的临床资料.所有患者均采取经十二指肠镜逆行胰胆管造影(ERCP),内镜下十二指肠乳头括约肌切开术(EST),取出胆总管结石,放置胆道塑料支架引流(ERBD).ERCP后3d内行LC,术后4d出院.出院后1～2周内再次行十二指肠镜取出胆道支架并行ERCP了解胆管有无残余结石.结果:35例患者均1次取净胆总管结石,1例EST术中出血,34例成功行LC,1例中转开腹行胆囊切除术.术后并发急性胰腺炎2例,所有患者均无胆漏、十二指肠穿孔、黄疸等并发症.结论:腹腔镜联合十二指肠镜治疗胆囊结石合并胆总管结石具有疗效确切、创伤小、恢复快等优点.

Clinical Study on Combined Usage of Laparoscopy and Duodenoscopy in the Treatment of Gallbladderstone and Common Bile Duct Stone

Objective：To study the chinical effect of the combined usage of laporoscopy and duodenoscopy in the treatment of gallbladderstone and common bile duct（CBD） stone.Methods：A retrospective study was made on 35 cases of gallbladderstone and commom bile duct stone undergoing combination of laparoscopy and duodenoscopy in our hospital from January 2009 to December 2010,and the clinical effect was analysed.All the cases were carried out endoscopic retrograde cholangiopancreatography （ERCP） and endoscopic sphincterotomy（EST） to pick out CBD stones,and endoscopic retrograde biliary drainage（ERBD） followed.Laparoscopic cholecystectomy（LC） was performed about three days after the ERCP.The biliary stent was picked out by duodenoscopy and all the patients were rechecked by ERCP to see whether any stone was left in bile duct within two weeks after being discharged.Results：The common bile duct stones were picked out thotoughly in all the 35 cases.1 case had intraoperative bleeding when treated by EST.Thirty-four cases were successfully treated by LC,and only 1 case was conversed to open laparocholecystectomy.No bile leakage,duodenal perforation or jaundice occurred except that two cases have acute pancreatitis after operation.Conclusions：The combination of laporoscopy and duodenoscopy to treat gallstone and CBD stone appears to be effective,minimally invasive and quick rehabilitation.It may be widely conducted as a minihurt technique in biliary tract surgery.