“三镜”联合治疗胆囊合并胆总管结石230例临床分析

目的探讨经十二指肠镜胆管逆行造影／Oddis括约肌切开取石（ERCP／EST）＋腹腔镜胆囊切除（LC）＋腹腔镜胆总管探查取石（LCBDE）联合治疗胆囊结石合并胆总管结石的临床效果和应用价值。方法采用ERCP／EST＋LC＋LCBDE联合治疗胆囊结石合并胆总管结石230例，ERCP／EST术后0～5d行LC或LC＋LCBDE。结果成功完成“三镜”联合治疗219例，成功率95．2％；LC中转开腹11例，EST取石失败6例，其中5例行LCBDE、1例LC中转开腹＋胆道镜取治愈石，6例胆总管切开取石术后均行一期缝合。出现1例严重并发症，经处理后最终顺利出院。结论ERCP／EST＋LC＋LCBDE联合治疗胆囊结石合并胆总管结石能达到与开腹手术相同的效果，而且具有微创的特点。

Treatment of cholecystolithiasis complicated with choledocholithiasis by combined three kinds of endoscopic surgeries in 230 cases

Objective To discuss the clinical effects and application value of treatment of cholecystolithiasis complicated with choledocholithiasis by the combination of duodenoscopic retrograde cholangiopancreatography （ERCP）/endoscopic Oddis sphincterotomy （EST） plus laparoscopic cholecystectomy （LC） and laparoscopic common bile duct stone extraction （LCBDE）. Methods 230 patients with cholecystolithiasis complicated with choledocholithiasis received the above combination treatment. LC or LC plus LCBDE were performed 0 - 5 d after the ERCP/EST. Results This combination treatment was successful carried out in 219 cases, and the achievement ratio was 95.2%. LC failed in 11 cases that were turned to laparotomy. Stone extraction by EST was failed in 6 cases, in which 5 ones received LCBDE and one received laparotomy and choledocboscopic stone extraction after the failure of LC. Six cases received primary suture after choledocholithotomy. Severe complications occurred in one case who was smoothly discharged after treatment. Conclusion The combination of ERCP/EST ＋ LC ＋ LCBDE has the same effect as that of laparotomy on cholecystolithiasis combined with choledocholithiasis and furthermore has the characteristic of minimal invasion.