十二指肠镜联合腹腔镜在胆囊结石合并胆总管结石患者治疗中的作用  

Laparoscopy combined with duodenoscopy for treatment of gallbladder and bile duct stones

作　　者：李春明[1] 胡凤丽[1] 禹宏[2] 田菲[1] 龙培滨[1] 

机构地区：[1]黑龙江省哈尔滨市第一医院消化内科,黑龙江哈尔滨150010 [2]黑龙江省哈尔滨市第一医院普外科,黑龙江哈尔滨150010

出　　处：《中国内镜杂志》2009年第10期1092-1093,1096,共3页China Journal of Endoscopy

摘　　要：目的探讨十二指肠镜联合腹腔镜治疗胆囊结石合并胆总管结石的疗效及临床意义。方法统计46例行十二指肠镜联合腹腔镜治疗的胆囊结石合并胆总管结石患者和20例开腹手术(OC)患者的临床资料,比较治疗成功率、并发症、住院时间的差异。结果取石成功45例,1例插管失败者经腹腔镜行胆囊切除并胆总管切开取石T型管引流术。术后高淀粉酶血症4例、水肿型胰腺炎2例,腹腔镜手术顺利,无胆道出血及腹腔感染发生,住院时间9～19d,平均13.5d。而20例开腹手术患者中术后出血1例、胆漏1例、胆管狭窄2例,住院时间12～22d,平均17.5d。结论十二指肠镜与腹腔镜联合治疗胆囊结石合并胆总管结石创伤小、恢复快、住院时间短,值得广泛推广。[ Objective ] To investigate the efiScacy of laparoscopy combined with duodenoscopy for the treatment of gallbladder and bile duct stones. [Methods] The clinical data of 66 cases with gallbladder and bile duct stones（ineluding 46 cases accepting combined endoscopies and 20 cases receiving open surgery） were analyzed retrospectively. The successful rates, complications and hospital stay were compared. [ Results ] Of the 66 eases, 45 cases had endoscopic sphineterotomy （EST） and laparoscopic choleeystectomy（LC） with no serious complications. One case was unsuccessful owing to difficulty in intubation during endoscopic retrograde choleeystopancreatography （ERCP） and had both LC and common bile duct exploration T-tube drainage. Perioperative complications during EST included hyperamylasemia in 4 cases,acute edematous pancreatitis in 2. No complications occurred in LC. The hospital stay was 9-19 days （mean 13.5 days）. In the 20 cases receiving open cholecystectomy（OC）, postoperative biliary leakage occurred in 1 patient, hemorrhage occurred in 1 and bile duct stricture in 2. The hospital stay was 12-22 days （mean 17.5 days）. No fatalities were noted. [ Conclusion ] Management of gallbladder and bile duct stones with laparoscopy and duodenoscopy is safe, effective and reliable.

关 键 词：十二指肠镜 腹腔镜 胆囊结石合并胆总管结石 

分 类 号：R657.42[医药卫生—外科学]