EST联合LC治疗胆囊结石胆总管结石  

EST combined with LC in the treatment of cholecystolithiasis with common bile duct stones

作　　者：王安[1] 黄海燕[1] 韩鑫[1] 刘燕[2] 

机构地区：[1]陕西省汉中市人民医院普通外科,陕西汉中723000 [2]陕西省汉中市人民医院消化内科,陕西汉中723000

出　　处：《中国普通外科杂志》2009年第8期790-792,共3页China Journal of General Surgery

摘　　要：目的探讨EST联合LC联合治疗胆囊、胆总管结石的可行性及优越性。方法先行EST(经内镜十二指肠乳头括约肌切开术)取出胆总管结石,再行LC(腹腔镜胆囊切除术),EST失败或不宜行EST者置ENBD(鼻胆管)再行LC+腹腔镜下胆道探查、胆道镜取石,或开腹行胆道探查术。结果全组99例,91例LC术前EST取石成功,3例LC术后EST取石成功,3例EST取石失败。2例年龄小于15岁者未行EST改行LC+腹腔镜下经胆囊管胆道镜胆道探查取石。3例EST取石失败,改行腹腔镜下胆道探查胆道镜取石、胆总管一期缝合或T管引流+LC,或开腹胆道探查一期缝合胆总管未置T管(已置ENBD)。无严重并发症,患者均治愈出院。结论EST联合LC联合治疗胆囊结石胆总管结石是安全、可靠的方法,软硬镜联合充分体现了"微创"治疗的优势。Objective To discuss the feasibility and superiority of EST combined with LC in treating cholecystolithiasis with common bile duct stones. Methods Patients underwent LC （laparoscopic cholecystectomy ） preceded by EST （endoscopic sphincterotomy ） and removal of common bile duct stones. ENBD （Endoscopic nasal biliary drainage tube ）was placed if EST failure and then the patient underwent LC ＋ laparoscopic biliary duct exploration （ LCBDE ） , or open operative bile duct exploration. Results In 91 of the 99 cases, LC preceded by EST and stone removal was successful, while EST following LC was successful in 3 cases, and stone removal by EST was unsuccessful in 3 cases. Two cases less than 15 years of age underwent LC ＋ LCBDE through the cystic duct and did not undergo EST. Three cases, who had EST failure, underwent LC ＋ LCBDE with primary suture of the common bile duct or LCBDE with T-tube drainage of common bile duct, or open bile duct exploration with primary suture of the common bile duct （ ENBD was in place）. All patients were discharged from hospital without serious complications. Conclusions EST combined with LC in treating cholecystolithiasis with common bile duct stones is a safe and effective method. Combination of endoscopic and laparoscopic procedures fully reflects the advantage of minimally invasive therapy.

关 键 词：胆结石/治疗 腹腔镜 十二指肠镜 胆道镜 

分 类 号：R657.4[医药卫生—外科学]