腹腔镜十二指肠镜联合治疗胆囊结石合并胆总管结石

目的探讨腹腔镜十二指肠镜联合治疗胆囊结石合并胆总管结石的效果和安全性。方法1998年5月～2008年7月,应用内镜下十二指肠乳头切开术（endoscopic sphincterotomy,EST）与腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）联合成功治疗胆囊结石合并胆总管结石459例。首先行ERCP,证实胆总管结石后行EST,网篮或气囊导管取石,必要时放置鼻胆管引流,血、尿淀粉酶正常,无发热、腹痛后l～5天内在全麻下行LC。结果成功完成内镜胆管取石及LC共438例,成功率95.4%;19例内镜取石未成功而行开腹手术;2例因无法耐受改为保守治疗。术后并发高淀粉酶血症73例,轻型胰腺炎32例,上消化道出血4例。252例术后随访3～6个月,无逆行胆管炎、EST后乳头狭窄等并发症,无胆管结石残留。结论腹腔镜十二指肠镜联合治疗胆囊结石合并胆总管结石安全可行,创伤小。     

十二指肠镜、腹腔镜联合治疗胆囊结石合并胆总管结石

目的探讨十二指肠镜、腹腔镜联合治疗胆囊结石合并胆总管结石的效果。方法2003年9月~2006年1月,对124例术前拟诊为胆囊结石合并胆总管结石的患者,行内镜下乳头切开术(endoscopic sphincterotomy,EST)及内镜下鼻胆管引流术(endoscopic naso-biliary drainage,ENBD),观察1~3d,无并发十二指肠乳头出血、十二指肠漏、胆管炎及胰腺炎者,在全麻下,采用三孔法或四孔法行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)。结果1例因十二指肠降部多发憩室,乳头藏匿在憩室内,寻找乳头失败;1例因乳头开口偏斜,且开口狭窄,造影导管及导丝不能顺利插入乳头,应用针形刀切开十二指肠乳头后,见到胆汁流出,但因胆总管直径较细(经开腹探查证实),胆管插管仍未成功;1例行LC时因胆囊周围严重粘连,Calot三角严重瘢痕性粘连,无法解剖,中转开腹。余121例成功施行EST、ENBD及LC,成功率97.6%,住院时间7~24d,平均12d。无十二指肠漏、十二指肠乳头出血、急性胆管炎及胆漏等与内镜操作有关的严重并发症。119例随访6~24个月,平均1...     

腹腔镜联合胆道镜或十二指肠镜治疗胆总管结石合并胆囊结石的对比研究

目的：探讨胆总管探查取石术（laparoscopic common bile duct exploration,LCBDE）联合腹腔镜胆囊切除术（1aparoscopic cholecystectomy,LC）与内镜下括约肌切开取石术（ endoscopic sphincterotomy,EST）联合LC治疗胆总管结石合并胆囊结石的临床疗效。方法2010年7月～2013年10月我院对136例胆总管结石合并胆囊结石分别采用LCBDE＋LC治疗（72例）或EST＋LC治疗（64例）,比较2组手术治疗成功率、术后并发症发生率、结石残留率、胃肠功能恢复时间、住院时间和费用等指标,随访2组远期并发症发生率。结果 LCBDE＋LC组手术时间（186±44） min明显短于EST＋LC组（221±41）min（t＝-4．687,P＝0．024）;LCBDE＋LC组住院时间（10．4±3．2）d,明显短于EST＋LC组（13．6±3．4）d（t＝-5．545, P＝0．000）;LCBDE＋LC组手术费用（8200±376）元,明显少于EST＋LC组（9600±420）元（ t＝-20．130,P＝0．000）;2组术后排气时间分别为（1．3±0．8）、（1．2±0．7）d,无统计学差异（t＝0．756,P＝0．451）;2组手术成功率分别为97．2％（70／72）、95．3％（61／64）,无统计学差异（χ2＝0．018,P＝0．893）;2组结石残留率分别为2．8％（2／70）、3．3％（2／61）,无统计学差异（χ2＝1．728,P＝0．531）,胰腺炎发生率有显著性差异[0 vs．6．2％（4／64）,P＝0．047]。随访1～3年,（2．5±0．5）年,2组反流性胆管炎发生率有统计学差异（χ2＝7．661,P＝0．004）。结论 LCBDE＋LC治疗胆囊结石合并胆总管结石安全、有效,术后并发症如胰腺炎和远期并发症返流性胆管炎比EST＋LC更具优势。     

腹腔镜联合十二指肠镜治疗胆囊结石合并胆总管结石

胆囊结石合并胆总管结石是临床常见、多发病之一,腹腔镜联合十二指肠镜具有患者创伤小、康复快、疗效好等优点。2006年4月至2009年8月我院选择性地施行腹腔镜联合十二肠镜治疗47例患者,效果良好,现报道如下。     

三镜联合治疗胆囊结石合并胆总管结石临床疗效及预后分析

目的:比较腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)联合胆总管探查术(腹腔镜、胆管镜和十二指肠镜三镜联合治疗)与内镜十二指肠乳头括约肌切开术(endoscopic sphincterotomy,EST)联合LC治疗胆囊结石合并胆总管结石老年病人(≥65岁)的临床疗效.方法:回顾性...     

十二指肠镜联合腹腔镜治疗老年胆囊结石伴胆总管结石

目的探讨经内镜乳头括约肌切开术(endoscopic sphincterotomy,EST)联合腹腔镜胆囊切除术(Laparoscopic cholecystectomy,LC)治疗老年人胆囊结石合并胆总管结石的疗效。方法回顾分析我院采用EST联合LC序贯治疗66例老年胆囊结石并胆总管结石患者的临床资料。结果十二指肠镜下胆总管结石取石成功率92.4%(61/66)。LC成功率93.2%(55/59)。EST+LC成功病例总住院时间8~27 d,平均13.5 d。本组18例EST后出现轻型胰腺炎,经保守治疗后好转,未出现其他严重并发症。结论 EST联合LC治疗老年人胆囊结石合并胆总管结石具有创伤小、恢复快、术后生活质量高等优点,是一种安全、有效、可行的微创手术方式。     

腹腔镜联合十二指肠镜治疗胆囊结石并胆总管结石

目的:探讨应用十二指肠镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)、内镜下十二指肠乳头切开术(endoscopic sphincterotomy,EST)联合腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗胆囊结石合并胆总管结石的适应证、手术时机和临床效果。方法:回顾分析为63例胆囊结石合并胆总管结石患者采用ERCP、EST联合LC序贯治疗的临床资料。先行EST取出胆总管结石,再于2～5 d内行LC。结果:61例(97%)成功施行EST,2例失败,59例成功完成LC,无出血、胆漏等并发症发生。结论:联合应用EST和LC治疗胆囊结石合并胆总管结石安全可行,具有患者创伤小、康复快、并发症少及无需T管引流等优点,充分体现了当今外科领域微创化的治疗原则,可作为治疗胆囊结石合并胆总管结石的最佳选择。     

十二指肠镜、腹腔镜联合治疗胆囊结石合并胆总管结石的体会

<正>胆囊结石合并胆总管结石占胆石症的10%～20%。近年,随着腔镜技术的发展,微创手术在某种程度上取代了传统开腹胆囊切除术、胆总管切开取石术。2009年5月至2010年9月我院为33例患者成功施行了十二指肠乳头切开     

腔镜胆总管切开术与内镜联合腹腔镜治疗胆总管结石的临床分析

目的对腹腔镜胆总管切开术与内镜联合腹腔镜治疗胆囊结石合并胆总管结石的疗效进行比较和评价。方法回顾性分析2002年7月至2007年7月，20例行腹腔镜胆囊切除、胆总管探查（LCD组），15例行腹腔镜胆囊切除联合内镜乳头括约肌切开取石术（EST＋LC组）患者的手术及术后情况。结果LCD组近期并发症发生率低于EST＋LC组（20％ vs 5％，P〈0．05），LCD组平均住院日和平均住院费用均明显低于EST＋LC组（P〈0．05），手术成功率两组差异无统计学意义（P〉0．05）。结论腹腔镜胆总管切开术是治疗胆囊结石并胆总管结石疗效肯定的微创手术。     

LC联合内镜EST治疗胆囊结石合并继发胆总管结石的临床研究

目的探讨腹腔镜胆囊切除术（LC）与内镜十二指肠乳头括约肌切开术（EST）联合应用治疗胆囊结石合并胆总管结石的临床效果。方法全组患者先行EST，在B超引导下使用取石网篮取干净总胆管结石，取石后常规放置ENBD管，1周后行鼻胆管造影明确胆总管无结石后行LC治疗。结果全组20例均获得成功，无中转开腹及严重并发症。结论LC与EST联合应用治疗胆囊结石合并胆总管结石，有较好的疗效，具有创伤小、效果好、并发症少、恢复快等优点。     

联合应用腹腔镜胆囊切除术和十二指肠乳头括约肌切开术治疗胆囊、胆总管结石

目的:总结腹腔镜胆囊切除术+十二指肠乳头括约肌切开术(LC+EST)治疗胆囊、胆总管结石的体会。方法:为6例患者行LC+EST。结果:本组病例均在术前行B超检查及MRCP检查,诊断为胆囊结石及胆总管结石,行LC+EST均获成功。手术顺利,无胆管并发症。结论:与传统的胆囊切除,胆道探查、取石,T管引流,或术中经胆囊管造影后探查胆总管以及行腹腔镜胆总管探查取石术(LCBDE)比较,经T管窦道行胆道镜取石,患者创伤小,痛苦轻,康复快。     

腹腔镜联合术中胆管造影、括约肌切开术序贯诊治胆结石病106例

目的 探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy，LC)联合术中胆管造影(intraoperative cholangiography，IOC)、术中括约肌切开术(intraoperative endoscopic sphincterotomy，IOEST)序贯诊治胆结石病的价值。方法回顾分析序贯诊治106例胆结石病的临床效果。结果64例(60．4％，64／106)术前诊断胆囊结石，经IOC发现有胆总管结石；序贯治疗手术成功率为93．4％(99／106)，98例胆总管结石被取净。术后并发症：水肿型急性胰腺炎6例(6．1％)、十二指肠穿孔1例(0．9％，1／106)、胆漏1例(0．9％，1／106)、气胸1例(0．9％，1／106)、漏诊十二指肠乳头癌1例(0．9％，1／106)、胃潴留2例(1．8％，2／106)。术后平均住院时间3．7d。结论LC联合IOC、IOEST能一次性微创诊治胆囊结石合并胆总管结石。     

Laparoscopic cholecystectomy combined with endoscopic sphincterotomy and stone extraction or laparoscopic choledochoscopy and electrohydraulic lithotripsy for management of cholelithiasis with choledocholithiasis

Summary Six hundred twenty-two laparoscopic cholecystectomies were performed at St. Vincent Hospital over a 14-month period. We reviewed the records of 366 of these patients who were referred to the authors. Thirty-six patients had suspected choledocholithiasis. The primary author (M.E.A.) performed 38 endoscopic retrograde cholangiopancreatography (ERCPs) on these patients for diagnosis and management. Seventeen of the 36 patients had common bile duct stones; 19 patients had negative studies. Of the 17 patients with choledocholithiasis, 15 had successful cannulation of the common bile duct, and, of these, 10 underwent laparoscopic cholecystectomy plus endoscopic sphincterotomy and extraction of the common duct stone(s). In one high-risk elderly patient, we extracted the stone from the common duct and left the gallbladder in situ. Two patients failed endoscopic cannulation and underwent open cholecystectomy with common bile duct exploration. Four additional patients, cannulated successfully, had unsuccessful endoscopic stone removal because the stones were too large or were impacted. Two of these patients underwent open cholecystectomy and common duct exploration. The two other patients underwent laparoscopic cholecystectomy and choledochoscopy through the cystic duct with the flexible choledochoscope. An electrohydraulic lithotripsy probe was then inserted through the choledochoscope to fragment the stones, and stone fragments were allowed to pass through the previously created sphincterotomy. We believe our data, supported by data in the literature, show that these alternative methods for treating choledocholithiasis are safe and effective and should be considered primary modalities for treating this condition now that laparoscopic cholecystectomy is the treatment of choice for cholelithiasis.     

腹腔镜胆总管切开术与内镜括约肌切开术治疗胆总管结石的比较

目的 探讨腹腔镜与内镜治疗胆总管结石的安全性有效性及适应证。方法 回顾性对比分析1997年7月至2006年6月腹腔镜胆总管切开术及内镜括约肌切开术治疗胆总管结石213例（腹腔镜组122例，内镜组91例）的临床资料。结果 腹腔镜组与内镜组相比手术成功率（96．7％vs．91．2％）及结石清除率（99．2％vs．94．0％）两组相似，近期并发症率（3．4％vs．13．3％，χ^2=6．864，P=0．009）较低；腹腔镜组的平均住院日（z=-2．713，P=0．007）及住院费用（z=-3．156，P=0．002）较高，主要原因是部分病例合并急性梗阻性胆管炎及胆源性胰腺炎预置鼻胆管引流控制感染，以及部分病例行胆总管T管引流等。内镜组发生重症胰腺炎3例（3．6％），其中死亡1例（1．2％）。结论 腹腔镜胆总管切开术保持Oddi括约肌完整，并发症较少、较轻，是治疗胆总管结石较为安全有效的方法。腹腔镜胆总管切开术适用于合并胆囊结石及胆总管扩张，急性梗阻性胆管炎及胆源性胰腺炎得到有效控制，全身情况好、能耐受麻醉手术者；内镜括约肌切开术适用于合并胆总管下段狭窄及结石嵌顿、急性梗阻性胆管炎、胆源性胰腺炎、全身情况差不能耐受麻醉手术的老年患者。     

Outcomes of cholecystectomy after endoscopic sphincterotomy for choledocholithiasis

Laparoscopic cholecystectomy (LC) for treatment of symptomatic common bile duct stones (CBDS) after endoscopic sphincterotomy (ES) is associated with increased conversion and complications compared with other indications. We examined factors associated with conversion and complications of LC after ES. A retrospective study of 32 patients undergoing ES for CBDS followed by cholecystectomy was undertaken. Surgical outcomes for this group were compared with a control population of 499 LCs for all other indications. Factors associated with open cholecystectomy and complications in the ES group were analyzed. Patients undergoing LC preceded by ES had a significantly higher complication (odds ratio [OR] = 7.97; 95% CI, 2.84–22.5) and conversion rate (OR = 3.45; 95% CI, 1.56–7.66) compared with LC for all other indications. Pre-ES serum bilirubin greater than 5 mg/dL was predictive of conversion (positive predictive value = 63%, P < 0.005). Patients with symptomatic CBDS that undergo LC after ES have higher complication and conversion rates than patients undergoing LC without ES. Pre-ES serum bilirubin is useful in identifying patients who may not have a successful laparoscopic approach at cholecystectomy. Presented at the Society of American Gastrointestinal Endoscopic Surgeons 2004 Annual Scientific Session and Postgraduate Course, Denver, Colorado, March 31, 2004 to April 3, 2004.     

腹腔镜胆囊切除术和内镜括约肌切开术治疗胆囊胆总管结石的观察

目的:探讨腹腔镜胆囊切除术和内镜括约肌切开术联合治疗胆囊胆总管结石的临床效果。方法:胆囊胆总管结石21例先行腹腔镜胆囊切除术,再行内镜括约肌切开术取出胆总管结石。结果:除1例腹腔镜胆囊切除术中转开腹手术外,余者内镜括约肌切开术取出胆总管结石均获成功。结论:腹腔镜胆囊切除术和内镜括约肌切开术联合治疗胆囊胆总管结石的临床效果可靠。     

腹腔镜联合术中胆管造影、括约肌切开术序贯诊治胆结石病5年经验总结

目的探讨腹腔镜胆囊切除术(Laparoscopic Cholecystectomy, LC )联合术中胆管造影(Intraoperative Cholangiography, IOC)、胰胆镜括约肌切开术(Intraoperative Endoscopic Sphincterotomy, IOEST)诊治胆囊结石合并胆总管结石疾病的价值. 方法回顾分析LC联合IOC、IOEST诊断和治疗106例胆囊结石合并胆总管结石患者的临床效果. 结果 60.4%(64/106)术前诊断胆囊结石,经IOC发现伴有胆总管结石;LC联合IOC、IOEST治疗胆囊结石合并胆总管结石手术成功率为93.4%(99/106),取净结石率99.0%(98/99).术后并发轻度急性胰腺炎6例(6.1%)、十二指肠穿孔1例(0.01%)、胆漏1例(0.01%)、气胸1例、漏诊十二指肠乳头癌1例(0.01%)、胃潴留2例(0.02%).术后平均住院时间3.7天. 结论 IOC能有效避免漏诊LC中胆总管结石;LC联合IOC和IOEST能一次性有效微创治疗胆囊结石合并胆总管结石.     

术中经鼻胆管胆道造影在两镜联合治疗胆囊合并胆总管结石中的应用

目的探讨内镜下十二指肠乳头括约肌切开术（endoscopic sphineterotomy，EST）联合腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）治疗胆囊合并胆总管结石术中经鼻胆引流管（endoscopic nasobiliary drainage，ENBD）胆道造影的价值。方法EST处理胆总管结石并放置ENBD管，在LC术中经ENBD管行胆道造影。结果46例术中经ENBD胆道造影均成功，造影时间5—15min，平均8．2min。术中经ENBD管胆道造影发现胆囊脱落至胆总管形成胆总管继发结石4例，其中2例术中再次内镜取出结石，2例结石直径〈3mm术中未处理，术后随访未见胆管结石及胆管炎发生。43例随访6—36个月，平均22个月，未发现胆总管再发结石及胆道逆行感染。结论两镜联合治疗胆囊结石合并胆总管结石，术中经ENBD胆道造影可及时发现并通过术中内镜及时处理继发性胆总管结石，减少术后胆管残余结石的发生。     

腹腔镜手术治疗胆囊切除术后胆总管结石

目的:探讨腹腔镜手术治疗胆囊切除术后胆总管结石的方法及可行性。方法:回顾分析11例胆囊切除术后胆总管结石患者行腹腔镜手术的临床资料,总结其手术适应证及疗效。结果:11例患者均采用腹腔镜手术清除结石,随访1~21个月,平均13个月,无异常。结论:腹腔镜手术治疗胆囊切除术后胆总管结石安全、可行。