腹腔镜联合内镜技术治疗胆囊结石合并胆管结石的临床研究

目的 探讨腹腔镜联合内镜技术在治疗胆囊结石合并胆管结石中的临床应用价值。方法 对2000-2005年应用腹腔镜联合十二指肠镜和纤雏胆道镜治疗的118例胆囊结石合并肝内外胆管结石病人行回顾性分析。其中胆囊结石合并胆总管结石102例，胆囊结石合并胆总管结石和左肝管结石16例。手术方式包括腹腔镜胆囊切除术（LC）联合经内镜括约肌切开术（EST）（49例）、LC联合胆道镜胆道棵查术（62例）、LC联合腹腔镜下左肝叶切除和胆道镜胆管棵壶术（7例）。结果96例病人术后得到随访和定期复查。影像学检查提示无残留结石。术后无严重并发症。4例接受LC结合胆道镜胆道棵查术的病人，中转开腹手术，其中2例由于存在离位胆管狭窄。1例由于肝门部严重粘连水肿，1例由于不易控制的动脉性出血。结论腹腔镜联合内镜治疗胆囊结石合并胆管结石安全、可行、疗效良好，应该在胆系结石病的治疗中得到推广应用。

Application of laparoscopy combined with endoscopy in the treatment of gallbladder calculi complicated with bile duct calculi

Objective To explore the application of laparoscopy combined with endoscopy in the treatment of gallbladder calculi complicated with bile duct calculi.Methods Laparoscopy combined with duodenoscopy and cholangioscopy were used in the treatment of 118 cases of gallbladder calculi complicated with bile duct calculi,including 102 cases of cholecystolithiasis combined with choledocholithiasis,16 cases of cholecystolithiasis combined with choledocholithiasis and left intrahepatic duct calculi between 2000 and 2005.The main surgical procedures included:LC combined with EST (49 cases),LC combined with cholangioscopic exploration (62 cases),LC combined with cholangioscopic exploration and laparoscopic left hepatic lobectomy (7 cases).Results Regular re-examination and follow up after operation showed that all the calculi were removed completely.And no serious complication occurred.Four out of 62 cases accepted LC with cholangioscopic exploration were converted to open operation after laparoscopic exploration,because of high bile duct stricture,or severe portal adhesion,or bleeding.Conclusion Laparoscopic combined with endoscopic technology is feasible,safe and effective in the treatment of gallbladder calculi and bile duct calculi.It should be used widely in biliary surgery.