腹腔镜联合胆道镜治疗重症急性胆管炎(附41例报告)

目的：探讨腹腔镜联合胆道镜在重症急性胆管炎（ACST）治疗中的应用价值。方法：腹腔镜胆总管切开、胆道镜探查取石、T管引流术（LCDE）。结果：腹腔镜胆囊切除术（LC）及LCDE37例,LCDE4例,无中转开腹。术中取尽结石33例,术后再次胆道镜取尽残石4例,因胆总管下段狭窄等原因择期开腹手术4例。术后发生胆漏4例,应激性溃疡出血1例,死亡2例。结论：腹腔镜联合胆道镜手术治疗ACST有效、可行。

Laparoscopic Treatment Adjuvant with Choledochoscopy for Acute Cholangitis of Severe Type:Report of 41 Cases

Objective:To assess the value of laparoscopic treatment adjuvant with choledochoscopy for acute cholangitis of severe type.Methods:Cholecystostomy(LC),laparoscopic CBD exploration(LCDE)and T tube drainage.Results:Thirty-seven patients were successfully treated by LC and LCDE,and 4 pantients by LCDE,and no one was taeated by laparotomy.The biliary stones were completely cleared during emergency operation in 33 patients,4 patients had residual stones which were removed by second choledochoscopic exploration,and 4 patients had open abdominal operation for other reasons later.After operation,4 patients had leakage of bile,1 patient suffered stress ulcer and bleeding and 2 patients died.Conclusion:Laparoscopy adjuvant with choledochoscopy was technically feasible and effective for patients with acute cholangitis of severe type.