腹腔镜、十二指肠镜联合治疗胆囊结石合并胆总管结石的临床应用

目的总结应用十二指肠镜下乳头括约肌切开术（endoscopic sphincterectomy,EST）联合腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）选择性治疗胆囊结石合并胆总管结石的经验。方法回顾性分析2008～2011年我院应用EST联合LC治疗72例胆囊结石合并胆总管结石的临床资料。胆囊结石直径0.5～3.0 cm,1枚或多枚,胆总管结石1.0～3.0 cm,数目1～3枚。均先行EST用碎石网篮碎石后取尽胆管结石,3～5天后再行LC术治疗胆囊结石。结果本组手术均获成功,无中转开腹,均痊愈出院。手术时间EST 46～100 min,LC 44～95 min,住院7～15 d,平均9.3 d。72例随访6～24个月,平均11.3月,无结石复发及严重并发症发生。结论 EST联合LC是治疗胆囊结石合并胆总管结石的安全、合理、有效的首选微创方法。

Laparoscopy Combined with Duodenoscopy for Gallbladder Stones Complicated with Common Bile Duct Calculi

Objective To summarize our experience on selective endoscopic sphincterectomy(EST) combined with laparoscopic cholecystectomy(LC) for gallbladder stones complicated with common bile duct calculi.Methods We retrospectively analyzed the clinical data of 72 patients with single or multiple gallbladder stones complicated with common bile duct calculi(1-3 stones),who received EST combined with LC in our hospital from 2008 to 2011.The diameter of the gallbladder stones ranged from 0.5 to 3.0 cm,and that of common bile duct calculi was ranged from 1.0 to 3.0 cm.LC was performed in 3 to 5 days after EST.Results The procedures were completed successfully in all the patients without conversion to open surgeries.The operation time for EST ranged from 46 to 100 min,and that for LC was 44 to 95 min.The patients were discharged from hospital in 7 to 15 days with a mean of 9.3 days.Follow-up was achieved in 72 patients for 6 to 24 months(mean,11.3 months),during which no recurrent stones or any severe complications occurred.Conclusion EST combined with LC is safe,feasible,effective,and minimally invasive for patient with gallbladder stones complicated with common bile duct calculi.