腹腔镜联合内镜逆行胰胆管造影术治疗胆囊结石合并胆总管结石的临床体会  

Laparoscopy combined with endoscopic retrograde cholangiopancreatography for cholecystolithiasis complicated with choledocholithiasis

作　　者：林涛[1] 周毅[1] 姚茹[1] 王钧[1] 方如塘[1] 姜莉[1] 王苏丽[1] 谢艳[1] 

机构地区：[1]解放军第四五一医院,陕西西安710054

出　　处：《腹腔镜外科杂志》2013年第5期368-370,共3页Journal of Laparoscopic Surgery

摘　　要：目的:探讨内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)联合腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗胆囊结石合并胆总管结石的最佳组合方式。方法:回顾分析2007年1月至2012年11月为203例胆囊结石合并胆总管结石患者行ERCP+内镜乳头括约肌切开术(endoscopic sphincterotomy,EST)联合LC的临床资料。其中138例先行ERCP+EST取出胆总管结石,再行LC(ERCP+LC组);65例先行LC再行ERCP+EST(LC+ERCP组)。对比分析两组手术成功率、总住院时间及并发症情况。结果:两组均无穿孔、出血及重症胰腺炎等严重并发症发生。ERCP+LC组住院时间短[(7.2±2.1)d vs.(8.1±1.9)d],差异有统计学意义(P<0.05)。ERCP+LC组术后胆管残余结石4例,发生急性轻型胰腺炎1例、胆管炎1例,并发症发生率为4.3%;低于LC+ERCP组的12.3%(P<0.05)。结论:对于胆囊结石合并胆总管结石的患者,先行ERCP+EST取石,再行LC,手术并发症较少,住院时间短,是较理想的组合方式。Objective：To evaluate the best combination of endoscopic retrograde cholangiopancreatography （ERCP） and laparoseopic cholecysteetomy （LC） for concomitant gallstones and common bile duct stones. Methods： The clinical data of 203 patients who underwent ERCP ＋ endoscopic sphincterotomy （EST） and LC for concomitant eholeeystolithiasis and choledocholithiasis from Jan. 2007 to Nov. 2012 were analyzed retrospectively. In 138 cases, common bile duct stones were removed by ERCP ＋ EST followed by LC （ ERCP ＋ LC group）. In 65 cases,LC was performed and followed by ERCP ＋ EST （ LC ＋ ERCP group）. Success rate of operations,hospital stay and complications were comparatively analyzed between the 2 groups. Results：There was no bleeding, perforation, severe pancreatitis or other severe complications occurred in any patients. The hospital stay of ERCP ＋ LC group was shorter than that of the LC ＋ ERCP group [ （7.2 ± 2.1 ） d vs. （ 8.1 ±1.9 ） d ] with a significant difference （ P 〈 0.05 ）. The overall incidence of complications in ERCP ＋ LC group was 4.3% （4 cases of residual bile duct stones,1 case of acute mild pancreatitis and 1 case of cholangitis） ,which was lower than that of the LC ＋ ERCP group （ 12.3 % ） （ P 〈 0.05 ）. Conclusions ： ERCP ＋ EST followed by LC is an effective and safe treatment with fewer complications and quicker recovery for cholecystolithiasis complicated with choledocholithiasis.

关 键 词：胆囊结石病 胆总管结石 胆囊切除术 腹腔镜 胰胆管造影术 内窥镜逆行 括约肌切开术 内窥镜 

分 类 号：R657.4[医药卫生—外科学]