ERCP/EST联合LC同期手术治疗胆囊结石合并胆总管结石的临床效果  

Clinical application of the simultaneous surgical treatment for gallstones withcommon bile duct stones by ERCP/EST combined LC

作　　者：陈正民 刘子祥 CHEN Zhengmin;LIU Zixiang(Department of General Surgery,the Second Affiliated Hospital of Bengbu Medical University,Bengbu,Anhui 233000,China)

机构地区：[1]蚌埠医科大学第二附属医院普通外科,安徽蚌埠233000

出　　处：《中华全科医学》2025年第5期773-775,784,共4页Chinese Journal of General Practice

基　　金：安徽省教育厅科研基金项目(2022AH051476);蚌埠医学院校级质量工程重点项目(2023fyjyxm15)。

摘　　要：目的 探讨经内镜下逆行胰胆管造影(ERCP)/内镜下十二指肠乳头括约肌切开术(EST)联合腹腔镜胆囊切除术(LC)同期手术治疗胆囊结石合并胆总管结石的临床应用效果。方法 回顾性分析蚌埠医科大学第二附属医院肝胆胰病区2022年2月—2024年6月经治的34例胆囊结石合并胆总管结石病历资料,患者先行全凭静脉麻醉或插管全麻下完成ERCP胆管取石,序贯完成LC。结果 全组有31例顺利完成ERCP/EST联合LC同期手术,另外3例因不同原因改行腹腔镜胆总管切开探查术(LCBDE)。因十二指肠憩室内乳头致插管失败1例,即刻改行LCBDE,完成取石后留置胆管内塑料支架,一期胆管缝合。ERCP术中碎石、取石困难1例,留置鼻胆引流管后,即刻改行LCBDE,取石后行胆管一期缝合。ERCP困难插管1例,即刻改行LCBDE,术中见胆汁浑浊,伴有脓性絮状物,胆管壁水肿明显,予以留置T管。术后有9例患者出现高淀粉酶血症,无穿孔、胆管炎、胰腺炎等严重并发症及死亡病例。结论 运用ERCP/EST联合LC同期手术治疗胆囊结石合并胆总管结石,简化了手术流程,缩短了住院时间,是安全、可行的手术方式,值得临床推广应用。Objective To explore the clinical application of a combined approach involving endoscopic retrograde cholangiopancreatography(ERCP)/endoscopic sphincterotomy(EST)in conjunction combined with laparoscopic cholecystectomy(LC)for the simultaneous treatment of gallstones and common bile duct stones.Methods A retrospective analysis was conducted on the medical records of 34 cases of gallbladder stones combined with common bile duct stones treated in the Hepatobiliary Pancreatic Ward of the Second Affiliated Hospital of Bengbu Medical University from February 2022 to June 2024,ERCP bile duct stone extraction was completed under full intravenous anesthesia or intubation general anesthesia,followed by LC.Results A total of 31 cases in the entire group successfully completed ERCP/EST combined with LC simultaneous surgery.In addition,three cases were switched to laparoscopic common bile duct dissection(LCBDE)for different reasons,while in one instance,the intubation process was unsuccessful due to the presence of a nipple in the duodenal diverticulum.The LCBDE was promptly substituted,and a plastic stent was left in the bile duct following stone removal.This was followed by primary bile duct suturing.In the course of ERCP surgery,a particular instance of complexity was encountered in the process of crushing and extracting stones.Following the insertion of a nasobiliary drainage tube,the administration of LCBDE was promptly discontinued and the bile duct was sutured during the initial stage of the procedure,subsequent to the removal of the stone.In one instance of difficulty with ERCP intubation,the procedure was immediately transitioned to LCBDE.During the operation,bile turbidity was observed,accompanied by purulent flocculent material and significant edema of the bile duct wall.The T-tube was left in situ.Postoperatively,9 patients developed hyperamylasemia.There were no severe complications such as perforation,cholangitis,pancreatitis or deaths.Conclusion The safety and feasibility of utilizing ERCP/EST in conjunction w

关 键 词：胆囊结石 胆总管结石 经内镜下逆行胰胆管造影 内镜下十二指肠乳头括约肌切开术 腹腔镜胆囊切除术 腹腔镜胆总管切开探查术 

分 类 号：R657.42[医药卫生—外科学]