肝内外胆管结石的内镜、腹腔镜联合治疗

目的 探讨肝内外胆管结石的内镜、腹腔镜联合治疗的最佳方法. 方法 2000年10月～2005年12月,我院收治肝内外胆管结石1 669例,根据病人结石具体情况分别采用内镜、腹腔镜联合微创治疗方案：一镜方案（单纯十二指肠镜治疗）,二镜方案①（十二指肠镜、腹腔镜联合治疗）或②（腹腔镜、胆道镜联合治疗）,三镜方案（十二指肠镜、腹腔镜、胆道镜联合治疗）,手助腹腔镜肝切除方案治疗,对术后情况进行观察分析. 结果 应用内镜、腹腔镜联合的微创方案治疗肝内外胆管结石1 636例,总成功率为98.0%（1 636/1 669）,术后无严重并发症发生. 结论 针对不同类型、不同程度的肝内外胆管结石病人,将内镜、腹腔镜联合应用,进一步扩大了微创治疗的范围,提高了成功率,充分体现了内镜、腹腔镜联合治疗的优越性.

Combination use of endoscopy and laparoscopy in the treatment of intra- and extra-hepatic bile duct stones

Objective To study the most appropriate approach of combination use of endoscopy and laparoscopy in the treatment of intra and extra-hepatic bile duct stones.Methods A total of 1 669 patients with intra-and extra-hepatic bile duct stones were treated from October 2000 to December 2005 in this hospital.According to patient's individual conditions,different surgical schemes were employed,including duodenoscopy only,combination of laparoscopy and duodenoscopy(or choledochoscopy),combination of duodenoscopy,laparoscopy,and choledochoscopy,and hand-assisted laparoscopic hepatectomy.The success rate and post-operative results were observed and analyzed.Results The combination use of endoscopy and laparoscopy was successfully carried out in 1 636 patients,the total success rate being 98.0%(1636/1669).There were no serious post-operative complications.Conclusions Combination use of endoscopy and laparoscopy can be employed for various conditions of patients with intra-and extra-hepatic bile duct stones.The technique integrates advantages of both digestive endoscopy and laparoscopy,broadens indications of minimally invasive treatment,and improves the success rate.