微创治疗胆总管结石的探讨

目的探讨腹腔镜胆总管探查取石术与经十二指肠镜乳头切开取石术后再行腹腔镜胆囊切除术在治疗胆总管结石中的优缺点.方法本组101例胆囊结石并发胆总管结石的患者,19例行腹腔镜胆总管探查取石术,82例行经十二指肠镜乳头切开取石术后再行腹腔镜胆囊切除术.结果19例行腹腔镜胆总管探查取石术,无一例出现并发症;82例经十二指肠镜乳头切开取石术后再行腹腔镜胆囊切除术,2例出现胰腺炎,1例可疑肠漏,3例因患者不能合作未能取石,其中有2例中转开腹.结论腹腔镜与十二指肠镜治疗胆总管结石为微创手术,各有其优点,比较而言,前者更优于后者,但不能完全取代后者,故术前应行全面检查,严格评估,尽可能地将住院时间、费用及合并症降到最低.

Common bile duct exploration by laparoscope and the combination of laparoscope and duodenoscope in the treatment of common bile duct stone

Objective To study the significance and difference between laparoscope common bile duct exploration(LCBDE) by laparoscope and the combination of laparoscope and duodenoscope in the treatment of common bile duct(CBD) stone. Methods From 2003 to 2005, 101cases of CBD stone were treated, 19 of them had LCDE, 82 had Endoscopic retrograde cholangiopancrealtography(ERCP) endoscopic sphincterotomy(EST) and followed by laparoscopic cholecystectomy(LC). Results LCBDE was successfully performed in all 19 cases, but six of 82 cases in the combination of laparoscope and duodenoscope had complications. Conclusions LCBDE and the combination of laparoscope and duodenoscope in the treatment of CBD are minimal traumatic operation with less complications since they are effective, minimal traumatic technique, they will be more and more widely applicated in surgery.