腹腔镜联合内镜微创手术治疗胆囊结石合并胆总管结石的临床观察

目的探讨腹腔镜联合内镜微创手术治疗胆囊结石合并胆总管结石的疗效。方法回顾性分析95例胆囊结石合并胆总管结石病人行腹腔镜联合内镜微创手术治疗的临床资料。结果本组63例先行十二指肠镜下乳头括约肌切开术(endoscopic sphincterotomy,EST)治疗,其中59例成功行EST+腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC),但术中并发十二指肠乳头少量出血2例,术后发生胆道感染1例,出现可疑十二指肠漏1例;4例EST取石失败后1周内改开腹手术,术后并发腹腔感染1例,胆漏1例。23例顺利行LC+腹腔镜胆总管探查取石术,其中腹腔镜胆囊管探查取石5例,腹腔镜胆总管切开取石18例。9例因疑诊胆总管结石而先行LC,术后2~4 d再行EST。术后随访6~12个月,均未出现反流性胆管炎、乳头狭窄等并发症,无胆管结石残留。结论腹腔镜联合内镜微创手术治疗胆囊结石合并胆总管结石效果满意。

Clinical Evaluation of the Microtrauma Surgery with the Laparoscopy and the Endoscopy for the Cholecystolithiasis and Choledocholith Patients

Objective To discuss the therapeutic effects of the microtrauma surgery with the laparoscopy and the endoscopy for cholecystolithiasis and choledocholith patients.Method The clinical data of 95 patients suffered from cholecystolithiasis and choledocholith was retrospectively analyzed.Results In the 63 cases tried to receive EST therapy firstly,there were 59 cases succeeded in EST＋LC with complications of duodenal papilla bleeding in 2 cases,infection of biliary tract in 1 and suspicious duodenum leakage in 1.In the 4 cases failed in EST,the open operations were used within one week with complication of infection of peritoneal cavity in 1,and biliary fistula in 1.And in the 23 cases underwent LC＋laparoscopic common bile duct exploration（LCBDE）,there were 5 cases had the calculus removed by laparoscopic transcystic common bile duct exploration（LTCBDE）,and 18 by laparoscopic choledochotomy（LCD）.And the last 9 cases underwent LC＋EST.During the 6 to 12 months follow-up,no one occurred refluxing cholangiolitis,stenosis of the duodenal papilla,nor the cholangiolithiasis residual.Conclusion It is effective and safe of the laparoscopy combined with endoscopy microtrauma surgery for cholecystolithiasis and choledocholith patients.