胆囊合并胆总管结石的诊治体会

目的探讨现代外科对胆囊合并胆总管结石的诊治方法。方法13年来我院对262例病人在准备行腹腔镜胆囊切除术前行ERCP或MRCP检查。其指征为:近期有胰腺炎发生或黄疸史,肝功能异常,B超或CT示胆总管扩张或有结石者。结果在此262例中,有257例发现结石并行EST或网篮取石成功,待胆总管恢复正常后行腹腔镜胆囊切除术。23例发现乳头狭窄或胆总管肿瘤,行EST、支架内引流或手术治疗。12例ERCP失败。结论胆囊合并胆总管结石的治疗策略为术前先行ERCP或MRCP EST,取石成功后再行LC为最佳策略。

The diagnosis and treatment of cholecy-stolithiasis combined with choledocholithiasis

Objective To investigate the modern surgical method to diagnose and treat the cholecy-stolithiasis with choledocholithiasis. Methods We have done ERCP or MRCP to 262 patients before the LC since 13 years ago.The indications were that had pancreatitis recently , had the history of jaundice , disfunction of Hepar or B-ultrasound or CT showd choledochectasia or cholecystolithiasis with choledocholithiasis. Results In the 262 cases, there were 257 cases with gallstone and received the EST or removed stone by basket successfully. Then they received the LC until the choledochus recovered. 23 cases were found stegnosis of duodenal papilla or choledochus tumor,and received the theatment of EST, internal drainage or surgery. 12 cases of ERCP failed. Conclusion ERCP or MRCP EST should be carried out cholecy-stolithiasis combined with choledocholithiasis is doing to remove the gollstone and then doing the LC.