双镜联合一期治疗胆囊结石合并胆总管结石27例

目的探讨内镜下乳头扩约肌切开取石（endoscopic sphincterotomy,EST）联合腹腔镜胆囊切除术（laparoscopiccholecystectomy,LC）一期治疗胆囊结石和胆总管结石的可行性。方法 2010年10月～2011年10月对27例胆总管结石合并胆囊结石在基础麻醉下行EST取石成功置入ENBD后改全麻下行四孔法LC。结果 25例成功施行EST联合LC一期手术,成功率92.6%（25/27）;1例EST取石未成功改开腹胆囊切除、胆总管取石、T管引流;1例EST成功后,LC术中见胆囊炎症明显,胆囊床渗血不止改开腹止血。术后发生胰腺炎1例,保守治疗治愈;迟发上消化道出血3例,经鼻胆管滴入去甲肾上腺素后血止;高淀粉酶血症13例,未处理自愈。残留结石3例,二次取石后痊愈。术后住院5～7 d,平均6 d。27例随访3～12个月,平均9个月,B超和肝功能检查均未见明显异常。结论 EST联合LC一期治疗胆囊结石合并胆总管结石可行。

Endoscopy Sphincterotomy Combind with Laparoscopic Cholecystectomy for One-stage Management of Cholecystolithiasis Complicated with Choledocholithiasis: Report of 27 Cases

Objective To study the feasibility of one-stage management with endoscopy sphincterotomy （EST） plus laparoscopic cholecystectomy （ LC ） for cholecystolithiasis and choledocholithiasis. Methods Twenty-seven patients with choledocholithiasis complicated with cholecystolithiasis, who underwent EST combined with LC in our hospital from October 2010 to October 2011, were enrolled into this retrospective analysis. In all the patients, under basic anesthesia, ENBD was placed after the stones were removed by EST, and then four-port LC was carried out under general anesthesia. Results The one-session success rate of the procedure was achieved in 25 of the 27 patients （92.6%）. The other two patients were converted to open surgery because of failure in EST or uncontrollable bleeding at the gallbladder bed caused by severe cholecystitis that was detected during LC. After the treatment, one patient developed pancreatitis, which was cured by conservative therapy; three patients developed upper gastrointestinal bleeding, which was controlled by norepinephrine dropping through a nasal biliary tube; 13 patients were diagnosed with hyperamylasemia that were cured spontaneously; 3 patients had residual stones and therefore underwent a second operation, which cured all of them. The mean postoperative hospital stay was 6 days （ ranged from 5 to 7 days） , and the patients were followed up for a mean of 9 months （ranged from 3 to 12 months） , during which no abnormalities were detected by B-ultrasonography, all the patients showed normal liver function by laboratory examination. Conclusion EST combined with LC is feasible for one-stage management of choledocholithiasis complicated with cholecvstolithiasis.