EST联合LC治疗胆囊结石胆总管结石

目的：探讨EST联合LC联合治疗胆囊、胆总管结石的可行性及优越性。方法：先行EST（经内镜十二指肠乳头括约肌切开术）取出胆总管结石，再行LC（腹腔镜胆囊切除术），EST失败或不宜行EST者置ENBD（鼻胆管）再行LC+腹腔镜下胆道探查、胆道镜取石，或开腹行胆道探查术。结果：全组99例，91例LC术前EST取石成功，3例LC术后EST取石成功，3例EST取石失败。2例年龄小于15岁者未行EST改行LC+腹腔镜下经胆囊管胆道镜胆道探查取石。3例EST取石失败，改行腹腔镜下胆道探查胆道镜取石、胆总管一期缝合或T管引流+LC，或开腹胆道探查一期缝合胆总管未置T管（已置ENBD）。无严重并发症，患者均治愈出院。结论：EST联合LC联合治疗胆囊结石胆总管结石是安全、可靠的方法，软硬镜联合充分体现了“微创”治疗的优势。

EST combined with LC in the treatment of cholecystolithiasis with common bile duct stones

ObjectiveTo discuss the feasibility and superiority of EST combined with LC in treating cholecystolithiasis with common bile duct stones. MethodsPatients underwent LC (laparoscopic cholecystectomy) preceded by EST（endoscopic sphincterotomy） and removal of common bile duct stones. ENBD(Endoscopic nasal biliary drainage tube)was placed if EST failure and then the patient underwent LC+laparoscopic biliary duct exploration(LCBDE),or open operative bile duct exploration. ResultsIn 91 of the 99 cases,LC preceded by EST and stone removal was successful,while EST following LC was successful in 3 cases, and stone removal by EST was unsuccessful in 3 cases.Two cases less than 15 years of age underwent LC+LCBDE through the cystic duct and did not undergo EST.Three cases, who had EST failure, underwent LC+LCBDE with primary suture of the common bile duct or LCBDE with T-tube drainage of common bile duct,or open bile duct exploration with primary suture of the common bile duct(ENBD was in place). All patients were discharged from hospital without serious complications.ConclusionsEST combined with LC in treating cholecystolithiasis with common bile duct stones is a safe and effective method. Combination of endoscopic and laparoscopic procedures fully reflects the advantage of minimally invasive therapy.