三镜联合治疗复杂性肝内外胆管结石的体会

目的:分析复杂肝内外胆管结石的有效治疗方法及三镜(腹腔镜、胆道镜、十二指肠镜)联合治疗的优势。方法:回顾分析2009年8月至2011年8月为100例肝内外胆管结石患者行三镜联合手术的临床资料,并对结果进行随访。结果:79例成功施行胆总管一期缝合术,术后5～8 d拔除鼻胆管,患者治愈出院。19例放置T管,12～15 d后带管出院,6～8周经胆道造影检查无特殊发现,遂拔除T管;其中3例发现胆道残留结石,术后经T管胆道镜取石成功,患者治愈出院。2例合并胆管癌,1例中转开腹,1例植入金属支架。术后随访3～6个月,2例胆管癌患者均死亡,余者均无结石复发、胆道狭窄等并发症发生。结论:三镜联合治疗复杂性肝内外胆管结石具有患者创伤小、康复快等特点,可降低并发症发生率及残石率,技术较成熟,值得临床推广应用。

The combination of three endoscopes ( laparoscope, choledochoscope, duodenoscope) in treatment of complicated intra- and extrahepatic bile duct calculi

Objective:To analyze the efficiency and superiority of combination of three endoscopes(laparoscope,choledochoscope,duodenoscope) in treatment of complicated intra-and extrahepatic bile duct calculi.Methods:The clinical data of 100 patients with intra-and extrahepatic bile duct calculi who underwent combined three-microscopic surgery from Aug.2009 to Aug.2011 was analyzed retrospectively.Results:Primary suture of common bile duct was successfully performed in 79 patients,the nasobiliary tube was removed 5-8 days later,and these patients were cured.T-tube was placed in 19 patients who were discharged with tube 12-15 days after operation.The T-tube was removed after no special finding was noticed in the cholangiography.Residual calculi in bile duct were found in 3 patients,and the calculi were removed through T-tube sinus by choledochoscope,patients were cured and discharged.2 cases were combined with bile duct carcinoma,1 case was converted to laparotomy,and 1 patient was implanted metal stent.During the follow-up of 3-6 months,2 patients with carcinoma of bile duct died,no complications such as calculi recurrence or biliary stricture were found in other patients.Conclusions:The combination of 3 endoscopes is mini-invasive,has advantages of quick recovery,low complication and residual calculi incidence.This procedure should be popularized in the premise of mature technology.