腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石  

Treatment of cholecystolithiasis complicated with choledocholithiasis by laparoscopy together with choledochoscopy

作　　者：张天华[1] 曾鹏飞[1] 

机构地区：[1]遵义医学院第三附院肝胆外科,贵州遵义563002

出　　处：《中国内镜杂志》2010年第3期309-310,314,共3页China Journal of Endoscopy

摘　　要：目的探讨腹腔镜、胆道镜治疗胆囊结石合并胆总管结石的临床应用价值。方法 2005年1月～2008年11月,实施三镜联合胆总管探查术153例,术中根据胆管结石情况,分别或联合4取石方法(水冲法取石、器械直接取石、胆道镜网篮取石、胆道镜激光碎石)取出胆管中结石。结果 138例成功,中转开腹15例,10例因术中明确肝内胆管结石残留,留置T管。3例术后经ENBD管造影发现胆管残留结石,使用十二指肠镜取石成功。结论联合使用4种取石方法,能有效地提高三镜联合胆总管探查术中结石取净率。【Objective】To investigate the value of clinical use of laparoscopy combined with choledochoscopy in treatment of cholecystolithiasis complicated with choledocholithiasis.【Methods】From January 2005 to November 2008,153 cases received the therapeutic procedures.According to the special conditions of bile duct stones,4 approaches of extraction of bile duct stones were performed,i.e.,saline flushing,tools laparoscopy or laparotomy,choledochoscopic basket manipulation and laser lithitripy.【Results】In 153 cases,the operations in 138 cases were successful.Fifteen cases were converted to laparotomy.Ten cases were converted to T-tube drainage because of the residual stones of intraheparic bile duct in operation.Three cases was found the residual bile duct stones on postoperative cholangiogram through ENBD-tube,which was successfully removed by postoperative endoscopic therapy.【Conclusion】It is proved that stone clearance can be markedly improved by the operation of combined duodenoscopic,laparoscipic and choledochoscopic common bile duct exploration through the combination of the four methods of stone extraction.

关 键 词：腹腔镜 胆道镜 十二指肠镜 胆总管结石 

分 类 号：R657.42[医药卫生—外科学]