三镜联合并胆总管切开一期缝合术治疗胆总管结石的体会

目的：总结腹腔镜、胆道镜、十二指肠镜（三镜）联合并胆总管切开一期缝合术治疗胆总管结石的经验。方法回顾性分析我院2012-08～2013-10应用三镜联合并胆总管切开一期缝合术治疗胆总管结石62例的手术疗效和经验。结果62例均成功取净结石。术后第1天、第3天复查肝功能及血、尿淀粉酶，术前肝功能异常者术后谷丙转氨酶（ ALT）、谷草转氨酶（ AST）、总胆红素（ TBIL）均明显下降，无一例出现血、尿淀粉酶增高。1例出现腹腔引流管引流淡黄色胆汁，3 d后自行消失。所有患者均获随访，随访时间3～6个月，术后2～8周复查磁共振胆胰管造影（ MRCP），62例均未见明确残石影，5例报告乳头狭窄影，但无自觉症状及体征，未予处理。术后3～6个月复查B超，报告胆管积气影3例，未予处理。结论三镜联合并胆总管切开一期缝合术治疗胆总管结石安全、有效、可行，值得推广应用。

Experience on three endoscopic combination and choledochotomy with primary suture in the treatment of choledocholithiasis

Objective To summarize the experience of combination of laparoscope , choledochoscope , duod-enoscope （ three endoscopic combination ） and choledochotomy with primary suture in the treatment of choledocholithi-asis.Methods Three endoscopic combination and choledochotomy with primary suture were used in 62 patients with choledocholithiasis .Results Stones in 62 patients were successfully removed .At the first day and the third day after operation, the reexamination of liver function and blood , urine amylase showed postoperative alanine aminotransferase （ALT）, aspartate aminotransferase（AST）, total bilirubin（TBIL） in patients with abnormal liver function before op-eration significantly decreased , no raising blood and urine amylase was found .In one case, postoperative peritoneal drainage showed yellow bile for 3 days.All patients were followed up , the follow-up time were 3~6 months.At 2~8 weeks after operation review of MRCP showed no clear residual stone shadow was found in 62 patients, 5 cases were reported papillary stenosis shadow , but no symptoms and signs , and were not treated .At 3~6 months after operation review of B-type ultrasound showed three cases were reported having bile duct gas accumulation and were not treated . Conclusion The three endoscopic combination and choledochotomy with primary suture in the treatment of choledo -cholithiasis is safe , effective and feasible , and for appropriate cases , it is worthy of promotion .