十二指肠镜联合腹腔镜治疗胆囊结石并肝外胆管结石22例分析

Duodenal endoscopy combined with laparoscopy in treatment of cholecystolithiasis associated with calculus extrahepatic bile duct in 22 cases

关键词:  胆囊结石  肝外胆管结石  内镜下十二指肠乳头括约肌切开取石术  腹腔镜胆囊切除术

Key words:  cholecystolithiasis  calculus of extrahepatic bile duct  endoscopic sphincterotomy  laparoscopic cholecystectomy.

摘要:

［目的］ 探讨内镜下十二指肠乳头括约肌切开( endoscopic sphincterotomy, EST)胆道取石联合腹腔镜胆囊切除术( laparoscopic cholecystectomy,LC)治疗胆囊结石并肝外胆管结石的临床应用价值。［方法］ 回顾性分析2001年8月～2006年7月大连医科大学第一临床学院行EST及LC联合治疗胆囊结石并肝外胆管结石的临床资料22例。［结果］十二指肠镜下行逆行胰胆管造影( endoscopic retrograde cholangiopancreatography, ERCP)全部成功,其中18例(81.8%)完成EST与LC联合治疗, 4例EST后未取净结石,行LC及胆总管切开胆道镜探查手术。10例出现EST后高淀粉酶血症，2例诊断为EST后插管性胰腺炎(轻型)，给予抑酶补液治疗后痊愈。LC无并发症。22例住院时间9～35 d,平均(17.32±1.58)d。［结论］EST联合LC是目前微创治疗胆囊结石并肝外胆管结石病较为理想的方法。

Abstract:

［Objective］To evaluate laparoscopy combined with duodenal endoscopy treatment for cholecystolithiasis and calculus of extrahepatic bile duct.［Methods］Retrospective analysis clinical data, 22 cases of our hospital from Aug 2001 to July 2006.［Results］ERCP was succeeded in 100%, combined EST and LC treatment was succeeded in 81.8%. 4 cases were treated by laparoscopic choledochotomy and choledochoscope after EST failure. 10 cases were hyperamylasemia and 2 cases were pancreatitis, which were cured by symptomatic treatment LC were all successfully given to certain paitents in 100%.There were no servious complications through observation. Length of stay was 9~35 days，the average was （17.32±1.58）d.［Conclusions］To treat complicated bile duct stones through duodenal endoscopy combined with laparoscopy is effective and minimally invasive treatment for patients, and the skill is an ideal choice for cure complicated bile duct stones at present.