内镜腹腔镜联合诊治胆囊结石并发可疑胆总管结石临床分析  

Application of Combined Laparoscopy and Endoscopy in Diagnosing or Treatment of Cholecystolithiasis Complicated with Choledocholithiasis

作　　者：杨勇[1] 王勇强[1] 陈红[1] 谭旭东[1] 杨汉新[1] 王飙 

机构地区：[1]成都市第一人民医院,四川成都610016 [2]成都市双流县人民医院,四川成都610200

出　　处：《现代临床医学》2007年第6期421-423,共3页Journal of Modern Clinical Medicine

摘　　要：目的:对临床疑有胆总管结石危险因素的胆囊结石患者,施行腹腔镜联合内镜诊治的价值及临床效果。方法:分析2005年5月至2006年12月我院收治的疑有胆总管结石危险因素的胆囊结石患者110例,其中腹腔镜联合内镜微创诊疗者51例,51例中施行LC+ERCP 9例、LC联合EST 23例、内镜取石术联合LC 17例,2例未成功转开腹手术;开腹手术组为接受小切口胆囊切除及胆总管探查的59例患者。分析两组术后转归、并发症发生率及平均住院时间。结果:腹腔镜联合内镜诊疗成功率为96.1%(49/51),内镜检诊出胆总管结石占33.3%(17/51),经内镜取石率为100%,未见近期并发症;内镜检诊出非结石性胆总管病变为44.5%(23/51),平均住院7.5 d。开腹手术组胆总管探查取石阳性率52.6%(31/59)、阴性率占47.4%,手术取净结石率51.6%(16/31),5周后胆管镜取净残余结石15例,该组平均住院为19 d。结论:对疑有胆总管结石危险因素的患者,内镜腹腔镜联合在诊治上相互补充,提高了微创胆管手术的可行性及安全性,术后并发症低、痛苦小、住院时间亦短。Objective： To investigate the curative effect of combined laparoscopy and endoscopy in diagnosing or treatment of gallbladder stones complicated with common biliary stones. Methods： From May 2005 to Docember 2006, the 110 cholecystolithasis cases complicated with biliary disease were divided into the microinvasive surgery and control group randomly. There were 51 cases in the microinvasive gronp and the patients were performed in endoscopic sphincterectomy（EST） combined with laparoscopic cholecystectomy, or endoscopic nasobile drainage （ENBD） and removing stones. There were 59 cases in the control group and traditional surgical operation alone. The clinical data of the two groups was contrasted in the same period. Results： The 96. 1% of patients were performed combined laparoscopes and endoscopes operation successfully and all stones were romoved. The choledocholithiasis were found in the 33.3% cases and 23 patients with gallstones were treated by laparoscopy cholecystectomy （LC） ＋ EST, 17 patients with LC ＋ ENBD were after 5 weeks of operation 15 cases common biliary stones were romoved with fibre cholecyst endoscope. Conclusions： Combined laparoscopy and endoscopy in diagnosing or treating common biliary disease have merits of small injury and safety. The curative effect is reliable in treatment of cholecystolithasis complicated with choledocholithiasis, and much better reduce average hospitalization days, improve clinical effects when compared those with open choledocholithotomy.

关 键 词：腹腔镜 胆囊切除术 胆总管结石 ERCP EST 

分 类 号：R657.42[医药卫生—外科学]