内镜联合腹腔镜治疗胆囊合并胆总管结石

目的探讨十二指肠镜下行乳头切开取石术（EST）联合腹腔镜行腹腔镜胆囊切除术（LC）。方法自2007年4月～2010年6月以来我院B超或ERCP诊断为胆囊合并胆总管结石的70例患者,胆总管结石直径〈1.0cm,结石为1～2枚49例2,枚以上21例。用针刀或弓刀行乳头预切开,在X线透视下用取石网或气囊取石。术后3～4d行腹腔镜胆囊切除术（LC）。结果全组70例患者67例成功行十二指肠镜下行乳头切开取石术（EST）联合腹腔镜胆囊切除术（LC）。术后胆总管残留结石3例,术后并发轻型胰腺炎5例,乳头出血1例,无胆管感染,LC术后无并发症发生。平均住院日（10±3）d。结论十二指肠镜下逆行胰胆管造影（ERCP）及乳头切开取石术＋腹腔镜胆囊切除术（LC）在治疗胆囊合并胆总管结石是安全有效微创手术方式。

Laparoscopy combined with duodenoscopy for treatment of gallbladder and bile duct stones

Objective The discussion of Endoscopic duodenal papilla incision line（EST） with Laparoscopic laparoscopic cholecystectomy（LC）.Methods 70 patients were diagnosed with Gallbladder and common bile duct stones by B-ultrasound or ERCP in our hospital from 2007.4 to 2010.6,the diameter of common bile duct stones is less than 1.0cm,there are 49 cases have 1-2 pieces of stone,while 21 cases are above 2pieces.Line with a knife or bow knife pre-cut the nipple,under X-ray net or air bag with stone stone.The LC would be operated 3-4 days after the surgery.Results The overall success of 67 cases of 70 patients duodenal endoscopy in the nipple line incision（EST） combined with laparoscopic cholecystectomy（LC）.Postoperative residual common bile duct stones in 3 cases,postoperative pancreatitis light 5,nipple bleeding in 1 case,and no biliary tract infection,LC were no complications after the surgery.The average time of stay in hospital is（10 ± 3）d.Conclusion ERCP and LC is safe and effective minimally invasive in the treatment of gallbladder and common bile duct stones side.