胆囊结石合并胆管结石微创治疗方案的选择

目的探讨胆囊结石合并继发胆道结石微创治疗的合理方案。方法108例胆囊结石合并可疑胆道继发结石均行腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC），其中腹腔镜联合胆道镜经胆囊管胆道探查取石（laparoscopic transcyctic common bile duct exploration，LTCBDE）＋LC70例，腹腔镜联合胆道镜胆总管切开胆道取石（laparoscopic common bile duct exploration，LCBDE）＋LC35例，其中放T管14例，不放T管21例，内镜乳头肌切开术（endoscopic sphincterotomy，EST）术后行胆囊切除3例。结果LCBDE＋LC术后放T管组中有1例胆漏经保守治疗治愈，4例术后胆道造影发现胆道残余结石经胆道镜取出结石治愈．其他病例无胆漏，术后3月复查B超无残余胆道结石，所有病例术后无胰腺炎发作。结论在胆囊结石继发胆道结石的治疗中合理选择多种微创手术方法能降低创伤及减少并发症的发生。

Selection of project of minimal invasive operations in gallstones with choledocholithiasis

Objective To study the suitable minimal invasive methods to treat the gallstones with secondary choledocholithiasis. Methods The choledocholithiasis, choledochectasia or combined with jaundice were found in 108 cases of gallstones. All these patients were divided into four groups according to the results of the examination before operation： 1.Laparoscopic cholecystectomy （LC） was performed in gallstones only. 2.LC＋laparoscopic transcyctic common bile duct exploration （LTCBDE） were performed in gallstones combined choledocholithiasis with cystic dilation. No T tube drainage was used. 3.LC＋laparoscopic common bile duct exploration （LCBDE） was performed in gallstones combined choledocholithiasis with no cystic dilation. Common bile duct was sutured in time without T tube drainage in those with a few stones. Otherwise, T tube drainage was performed in those having more stones and edema at the end of common bile duct. 4.Endoscopic sphinctectomy （EST） was performed in the age more than 80 years old patients or having serious heart or lungs disorders, LC was performed one month after EST. Results LC was performed in all 108 cases. LTCBDE＋LC 70 case, LCBDE＋LC 35 cases, T tube drainage in 14 cases, 21 cases without T tube drainage, EST were performed in 3 cases. Bile leakage was found in one case in LCBDE ＋ LC. Stones remained in common bile duct after operation in 4 cases in LCBDE＋LC. No pancreatitis was found in all patients. Conclusion The damage and complications will be reduced in gallstone combined with choledoeholithiasis if the suitable minimal invasive surgery technique is chosen.