ERCP联合腹腔镜对困难胆囊切除术医源性胆道损伤的价值

目的探讨ERCP联合腹腔镜对于预防困难胆囊切除术中胆道损伤的作用。方法分析收治的579例困难胆囊切除患者的临床资料,根据选择的治疗方式,分为两镜联合治疗组282例（联合组）和常规开腹手术组297例（常规组）,比较两组手术时间、术中出血量、术后胆瘘发生率、住院时间、腹腔引流管拔管时间。结果两镜联合治疗组280例顺利完成LC,2例中转开腹;联合组与常规组手术时间分别为（85.7±26.5）ml和（142.1±22.6）min（P〈0.001）、术中出血量为（35.2±11.6）ml和（81.5±19.2）min（P〈0.001）、住院时间为（6.5±1.2）d和（10.2±2.8）d（P〈0.001）、腹腔引流管拔管时间为（2.9±2.1）d和（5.2±2.7）d（P〈0.001）,联合组术后无胆瘘发生。结论 ERCP联合腹腔镜可以减少困难胆囊切除术中医源性胆道损伤并发症的发生。

ERCP combined with laparoscopic cholecystectomy can prevent iatrogenic bile duct injury

Objective To investigate ERCP combined with laparoscope for prevention of bile duct injury in difficult laparoscopic cholecystectomy.Methods 579 patients with difficult laparoscopic cholecystectomy were divided into group A and group B.Group A（282 cases）was treated with ERCP combined with laparoscope group.Group B（297 cases）was treated with conventional treatment.The operative time,blood loss,postoperative biliary fistula incidence,hospitalization time and peritoneal drainage tube extubation time were compared between the two groups.Results There were 280 cases successfully completed operation of group A.2 cases were converted to laparotomy,The operation time,blood loss,the incidence of postoperative biliary fistula,hospitalization time and peritoneal drainage tube extubation time of group A were significantly lower than that of group B.Conclusion ERCP combined with laparoscope can significantly reduce the incidence of bile duct injury iatrogenic complications in the difficult laparoscopic cholecystectomy.