十二指肠镜联合腹腔镜治疗胆囊结石合并胆总管结石  

Laparoscopic cholecystectomy for the treatment of patients with cholelithiasts concurrent with choledocholithiasis

作　　者：王红禄[1] 赵振生[1] 陈宁[2] 胡毅[2] 曹双军[1] 李晋[1] 石庆龙[1] 

机构地区：[1]首都医科大学燕京医学院附属房山区良乡医院普外科,北京102401 [2]首都医科大学燕京医学院附属房山区良乡医院CT室,北京102401

出　　处：《国际外科学杂志》2011年第5期301-304,共4页International Journal of Surgery

基　　金：首都医学发展科研基金（No.2007-3150）

摘　　要：目的 探讨螺旋CT三维胆道成像联合内镜下逆行胆胰管造影（ERCP）、内镜Oddi括约肌切开取石术（EST）与腹腔镜胆囊切除术（LC）对胆囊结石合并胆总管结石的治疗作用.方法 回顾性分析2007年7月至2009年6月期间,应用螺旋CT三维胆道成像联合十二指肠镜及腹腔镜治疗胆囊结石合并胆总管结石患者30例的方法与经验.并与2005年7月至2007年6月期间,传统开腹胆囊切除、胆总管切开取石、T管引流术治疗胆囊结石合并胆总管结石36例患者进行对比,比较两组患者术后恢复情况.结果 两镜联合组全部病例取得成功,ERCP并发症2例,均为急性轻型胰腺炎,螺旋CT三维胆道成像胆总管、肝总管、左右肝管显影率为100%,胆囊管显影率为73%,可清晰显示胆囊管的走行及汇入胆总管的位置.术后下床活动时间、胃肠功能恢复时间、进食时间、术后住院时间均优于传统手术组（P＜0.05）.结论 螺旋CT三维胆道成像联合十二指肠镜与腹腔镜治疗胆囊结石合并胆总管结石具有安全、创伤小、术后恢复快,且能减少术中胆管损伤的优点,具有较好的应用价值.Objective To summarize the curative effect of three-dimensional spiral CT cholangiography combined with endoscopic retrograde cholangiopancreatography（ERCP）,endoscopic sphincterotomy（EST）and laparoscopic cholecystectomy（LC）for treatment of patients with cholelithiasts concurrent with choledocholithiasis.Methods A retrospective analysis was carried out for 30 cases of cholelithiasts concurrent with choledocholithiasis which were treated with ERCP and three-dimensional spiral CT cholangiography before laparoscopic cholecystectomy from July 2007 to June 2009.And the post operation parameters were compared with those of 36 patients who received traditional operation from July 2005 to June 2007.Results All the procedures were successfully accomplished.Complication occurred in 2 cases.both with mild acute pancreatitis.With the three-dimensional spiral CT cholangiography,the intra-hepatic bile ducts,the hepatic bile duct and the common bile duct were visible in 100 percent patients,and choleeyst bile duct was visible in 73%patients,and three-dimensional spiral CT cholangiography can tell the position of cholecyst duct,then can decrease the possibility of damage of bile duct.The gastrointestinal function recovery time and feeding time after operation,the in hospital time after operation in the ERCP and three-dimensional spiral CT cholangiography before laparoscopic cholecystectomy group were superior to those of the traditional operation patients（P〈0.05）.Conclusion ERCP and three-dimensional spiral CT cholangiography before laparoscopic cholecystectomy for treatment of patients with cholelithiasts concurrent with choledocholithiasis is safe,with less trauma and fast recover after operation and Can decrease the possibility of damaging bile duct,which can be used widely.

关 键 词：腹腔镜胆囊切除术 内镜下逆行胆胰管造影术 螺旋CT三维胆道成像 

分 类 号：R657.4[医药卫生—外科学]