两镜法治疗胆囊合并胆总管结石36例疗效分析

目的探讨十二指肠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)治疗胆囊合并总胆管结石的疗效. 方法胆囊合并胆总管结石36例,首先经EST取出胆管结石,然后采用LC切除胆囊. 结果 EST成功34例(94.4%); 失败2例,均因胆管末端狭窄,开腹行胆管空肠吻合术治愈.腹腔镜手术34例,成功32例(94.1%),2例中转开腹. 结论 EST联合LC是治疗胆囊合并胆管结石的优选术式,EST失败者主要原因为胆管狭窄,应首选胆管空肠吻合术.

Endoscopic sphincterotomy combined with laparoscopic cholecystectomy for the treatment of gallstones complicated with common bile duct stones: Analysis of 36 cases

Objective To evaluate the curative effect of endoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC) in the treatment of gallstones complicated with common bile duct stones. Methods A total of 36 cases of gallstones complicated with common bile duct stones were enclosed. First EST was performed to remove the bile duct stones. Then LC was applied to resect the gallbladder. Results EST was successfully performed in 34 cases (94.4%) and failed in 2 cases because of the terminal stricture of the bile duct that was afterwards cured by an open choledochojejunostomy. LC was performed following EST in 34 cases, 32 of which were successful (94.1%) and 2 of which required a conversion to open surgery. Conclusions EST combined with LC is the best way for treating gallstones complicated with common bile duct stones. The biliary stricture mainly accounts for the failure of EST and should be treated by choledochojejunostomy as the first choice.