腹腔镜胆道镜十二指肠镜联合治疗原发性肝胆管结石36例

目的　探讨三镜联合治疗原发性肝胆管结石和肝胆管狭窄的手术方法 ,提高治愈率和避免多次开腹手术。方法　采用腹腔镜胆道镜十二指肠镜 (三镜 )联合治疗原发性肝胆管结石 36例。经十二指肠镜手术治疗肝外胆管尤其是胆总管下端结石及狭窄。经腹腔镜手术行胆囊切除及结合胆道镜行肝胆管探查术和耐高压球囊导管扩张术 (LPBD) ,解除肝门部胆管狭窄及行肝内胆管支架引流术。术后 2月行胆道镜和 或十二指肠镜治疗残余结石。结果　 36例均获成功 ,未再施行开腹手术。结论　三镜联合治疗原发性肝胆管结石具创伤小、结石除净率高 ,狭窄胆管球囊导管扩张后置支架安全有效。

Combination of laparoscopy, choledochoscopy and duodenoscopy for treatment of primary bile duct stones——report of 36 cases

Objective Multiple endoscopy were combined to treat special primary bile duct stones. Methods 36 patients were admitted to our hospital endoscopic sphincterotomy, mechanical lithothipsy, nasobiliary drainage (duodenoscopy) was first adopted, then followed by laparoscopic CBD exploration(choledochoscopy) and intraoperative choledochoscopy and dilatation to treat the stenosis at papillary and the hepatic portal and clear stones. Postoperative removal of bile duct residual stones by choledochoscopy and duoderoscopy, extraction, intradranage and EST/EPBD was recommended for retained bile duct stones or papillary stenosis. Results Satisfactory results were obtained. Neither conversion, nor serious complications were observed. Time for the endoscopies remained same as that for open choledocholithotomy and choledochojejunostomy, while postoperative hospital stay for the formal reduced obviously than the latter. Conclusions The combined endoscopy of the kind is practicable and safe for sophisticated endoscopists, and sometimes able to substitute some open choledocholithotomy and choledochojejunostomy.