ERCP、EST联合LC治疗胆石症临床分析  

Clinical analysis on the treatment of cholelithiasis with LC combined with ERCP and EST in 38 cases

作　　者：李忠[1] 侯振宇[1] 郭春良[1] 

机构地区：[1]武警医学院附属医院普通外科,天津300162

出　　处：《武警医学院学报》2008年第4期318-320,共3页Acta Academiae Medicinae CPAPF

摘　　要：【目的】探讨内窥镜逆行胆胰管造影术(ERCP)、内窥镜下括约肌切开术(EST)联合腹腔镜胆囊切除术(LC)治疗胆石症的临床疗效分析。【方法】回顾性分析我院开展的ERCP+EST+LC治疗胆囊结石合并胆总管结石患者38例。其中LC术前发现的胆总管结石37例,LC术后确诊的胆总管残留结石1例。【结果】35例LC术前取石成功,胆总管结石完全排出,其中22例在EST后2周内自然排出,8例采用取石网篮取出,5例采用碎石篮先碎石,然后再取出或待其自行排出。LC术前EST未成功2例患者中,1例行LC+术中胆道镜取石成功,1例行开腹手术。LC术后发现胆总管残留结石的1例患者,经过EST切开取石成功。LC术全部成功,无手术并发症。【结论】针对患者不同的病情合理选择分次施行ERCP+EST+LC可提高胆总管结石合并胆囊结石的治愈率。[Objective] To assess the clinical effectiveness on the treatment of cholelithiasis with LC combined with endoscopic retrograde cholangio pancreatography （ERCP） and endoscopic sphincterotomy （EST）. [Methods] The clinical effectiveness of ERCP ＋ EST ＋ laparoscopic cholecystectomy （LC） in 38 diagnosed cases with cholecystolithiasis and common duct stones were retrospective analyzed. Among them, 37 patients with common duct stones were found before LC, 1 patient with common duct stones was found after LC. [Results] Successful removal of calcuci in 35 patients. Calculus was freely discharged in 22 patients after 2 weeks of EST. In the rest 13 cases, calculi were removed by web basket in 8 cases and in the other 5 cases calculi were treated with macadam basket. Calculi were taken out or freely discharged after macadam. In 2 cases, EST failed before LC, LC ＋ choledochoscope was adopted, then stones were succefully removed in one case during LC ＋ cholodochoscope and the other case, stones were removed after laparotomy. The operation of LC was totally succeed and with no complication. [Conclusions] According to the patients＇ pathogenetic condition reasonable selection of ERCP ＋ EST ＋ LC may raise the cure rate of the cholecvstolithiasis and common duct stones.

关 键 词：内窥镜逆行胆胰管造影术 内窥镜下括约肌切开术 腹腔镜胆囊切除术 胆石病 

分 类 号：R657.4[医药卫生—外科学]