中药配合腔镜治疗高龄胆囊合并胆总管结石69例

目的:探讨联合运用腹腔镜、十二指肠镜、胆道镜与中药治疗高龄胆囊及胆总管结石的疗效。方法:69例高龄胆囊及胆总管结石病人,平均年龄72.6岁,平均病程5.8d。先行十二指肠镜逆行胆胰管造影(ERCP),通过十二指肠镜Oddi括约肌气囊扩张(EPBD)或切开(EST)取石,再行腹腔镜胆囊切除(LC)、胆总管探查术(LCBDE),术中配合胆道镜取石、激光碎石,术后运用中药及针灸。结果:69例ERCP全部成功。9例EPBD后取石成功;60例行EST,成功57例;EST后取石成功50例,失败后行鼻胆管引流(ENBD)4例。经ERCP、EST取石后62例均II期行LC,成功60例,中转剖腹手术2例。EST失败和EST取石失败者7例,II期行LC并LCBDE,均获得成功。术中术后无残余结石及严重并发症。均在术后3～7d出院,随访6～9个月均健康生活。结论:三镜联合手术结合中药治疗高龄胆囊合并胆总管结石,切实可行,安全可靠,具有创伤小、痛苦轻、术后恢复快等特点。

Traditional Chinese Medicine Therapy Combined with Laparoscopy, Duodenoscopy and Choledochoscopy to Treat Venerable Aging Patients with Choledocholithiasis and Gallbladder Stones: Report of 69 Cases

Objective To investigate the clinical value of traditional Chinese medicine therapy combined with laparoscopy, duodenoscopy and chledochoscopy to treat venerable aging patients with choledocholithiasis and gallbladder stones. Methods Sixty-nine elderly patients with choledocholithiasis combined gallbladder stone received endoscopic retrograde cholangio-pancreatography （ERCP）, endoscopic sphincterotomy （EST）, laparoscopic cholecystectomy （LC） or laparoscopic common bile duct exploration （LCBDC） associated with postoperative traditional Chinese medicine and acupuncture therapy. Results All 69 patients received ERCP successfully. EPBD was successful in 9 cases. The other sixty patients received EST, of them 57 were successful and 50 patients completed EST. The 62 cases receiving the ERCP and EST had secondary LC, of them 60 patients were successful and only 2 patients were transversed to open approach. Seven patients failed from EST and were given LC and LCBDE, all of them had good recovery. All 69 patients had good recovery without residual stones and severe complications, they were discharged 3-7 days after operation. There were no long-term complications at the end of six-month followed-up. Conclusion Combined laparoscopy, duodenoscopy and choledochoscopy with TCM therapy is safe and feasible with the advantages of fast recovery, less injury and suffering, especially in elderly patients with gall bladder stones and choledocholithiasis.