腹腔镜联合内镜一期治疗胆囊结石合并肝外胆管结石

目的:探讨腹腔镜胆囊切除术(LC)联合术中内镜下逆行胆胰管造影(ERCP)及乳头切开(EST)取石一期治疗胆囊结石合并肝外胆管结石的可行性和安全性。方法:回顾分析2003年9月至2004年9月,应用LC联合术中ERCP一期治疗胆囊结石合并肝外胆管结石15例的临床资料,分析原发疾病,手术方式,术后康复,住院时间及并发症。结果:术前明确胆总管结石5例中4例先行术中ERCP取石,取石成功后再行LC;余11例先行LC,继而行ERCP取石。其中肝功能异常和(或)胆总管扩张的10例术中经胆囊管胆道造影(TCC),除1例插管失败外,余9例通过TCC证实胆总管结石。手术均获成功,取石成功率为100%。手术时间40~90min,平均为68min,术后2例出现一过性血淀粉酶升高,无明显出血、胆漏等并发症,术后住院3~10d,平均为4d。结论:LC联合术中ERCP一期治疗胆囊结石合并肝外胆管结石安全、有效,可避免不必要的ERCP及因术后ERCP失败而致患者再次手术。

LC combined intraoperative ERCP for the treatment of cholelithiasis with choledocholithiasis

Objective:To explore the feasibility and safety of LC combined intraoperative ERCP for the onestage treatment of cholelithiasis with choledocholithiasis.Methods:Fitfeen patients with cholelithiasis and choledocholithiasis were treated by the combined procedures and the ope ration,postoperative recovery,hospital stay,and complications were analysed.Results:Four of five patients with preoperativediagnosed choledocholithiasis were successfully treated by ERCP at first,then underwent LC.Other 11 patients,after choledocholithiasis were comfirmed by TCC,performed intraoperatively in 9 of 10 patients with suspected choledocholithiasis,ERCP was successfully performed.Two patients had postoperative hyperamylasemia,no other complications occured.Mean postoperative hospitalization was 4 days.Conclutions:Combined LC/ERCP can be performed safety,and there are advantages including onestage treatment,avoidance of unnecessary preoperative ERCP,and eliminating the need to return to the operation room following failure of postoperative ERCP.