胆囊结石合并胆总管结石的微创保胆治疗

目的:评价胆囊结石合并胆总管结石微创保胆治疗的临床效果,探讨胆石症的微创外科治疗新方法。方法:2008年7月至2012年9月为41例胆囊结石并胆总管颗粒状结石患者行内镜逆行胰胆管造影(endoscopic retrograde cholangio-pancreatography,ERCP)+Oddi括约肌切开术(endoscopic sphincterotomy,EST),术后放置鼻胆管引流(endoscopic naso-biliarydrainage,ENBD),并行ENBD管造影以证实胆总管结石是否取尽,术后1～3 d行微创保胆取石术(endoscopic minimally invasivecholecystolithotomy,EMIC)。结果:41例手术均获成功,ERCP胆总管取石时间平均(51±9.1)min,保胆手术时间平均(48±7.3)min,术后均无并发症发生;术后住院2～5 d,平均(3.5±0.6)d。结论:ERCP+EST结合EMIC治疗胆总管结石并胆囊结石是安全、可行的,减轻了患者的痛苦,缩短了住院时间,增加了医疗效率,扩大了保胆手术的治疗范围。

Minimally invasive cholecystolithotomy in the treatment of cholecystolithiasis and choledocholithiasis

Objective:To evaluate the clinical efficacy of endoscopic minimally invasive cholecystolithotomy(EMIC) in the treatment of cholecystolithiasis and choledocholithiasis,and investigate the new therapy of cholelithiasis in mini-invasive surgery.Methods:Forty-one patients who were diagnosed as cholecystolithiasis and common bile duct granulo-calculi between Jul.2008 and Sep.2012 underwent endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic sphincterotomy(EST).Endoscopic naso-biliary drainage(ENBD) tube was placed so that cholangiography could be applied to verify whether calculi were completely removed.Results:The operations were successfully completed in these 41 cases.The ERCP time was(51±9.1) min,the EMIC time was(48±7.3) min,and there were no serious postoperative complications.The postoperative hospital stay was 2-5 d,mean(3.5±0.6) d.Conclusions:It is feasible and safe to practice ERCP+EST and EMIC in patient with cholecystolithiasis and choledocholithiasis.It can decrease suffering of patients,decurtate postoperative hospital stay,increase therapeutic efficacy,and expand the application of EMIC.