十二指肠镜、腹腔镜和胆道镜联合治疗胆道结石

目的 探讨胆囊结石合并胆总管结石、乳头狭窄、结石性胰腺炎等的微创外科治疗。方法 先行十二指肠镜逆行胰胆管造影（ERCP）＋乳头括约肌切开（EST）＋网篮取石（ESR）＋内镜鼻胆管外引流术（ENBD），术后3—7d再行腹腔镜胆囊切除术（LC）及术中胆道镜取石治疗胆囊结石合并胆总管结石、乳头狭窄、结石性胰腺炎286例，其中胆囊结石合并肝外胆管结石214例、肝外胆管结石＋乳头炎性狭窄39例、单纯乳头炎性狭窄22例、结石性胰腺炎28例。结果 ERCP成功率100％，EST成功率96．2％，tc（除外2例中转开腹）及术中胆道镜全部成功，无严重并发症发生。结论 十二指肠镜、腹腔镜和术中胆道镜联合治疗复杂性胆道结石，达到了治疗该类疾病的最小创伤，是目前治疗复杂性胆道结石的理想选择。

Combined laparoscopy, endoscopy and choledochocopy treatment for cholelithiasis

Objectives To evaluate minimally invasive treatment of constrictive papillitis chronic obstructive pancreatitis or gall bladder problems were given endoscopic. Methods First, 286 patients were given ERCP+EST+ESR+ENBD, after 3~7 days, all patients were underwent LC and part of them were removed stones by cholelith endoscopy. Among the paitents, 214 suffered from cholecysto lithiasis combined with choledocholithiasis, 39 suffered from choledocholithiasis and constrictive papillitis, 22 suffered from simplistic constrictive papillitis, 28 suffered from obstructive pancreatitis. Results ERCP was succeeded in 100%, EST was succeeded in 96.2%, and LC (except 2 cases divert to traditional operation) with cholelith endoscopy were all successfully given to certain paitents in 100%. There were no servious complications through observation. Conclusions To treat complicated bile duct stones through dudenal endoscopy. Laparoscopy combined with cholelith endoscopy is effective and minimally invasive treatment for patients, and the skill is an ideal choice for cure complicated bile duct stones at present .