摘要
目的:探讨腹腔镜技术下胆囊结石合并胆总管结石微创治疗策略的合理选择。方法:总结为76例胆囊结石合并胆总管结石患者采用腹腔镜联合胆道镜、十二指肠镜等不同组合的微创手术治疗经验。结果:37例患者于腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)前行内镜下十二指肠乳头括约肌切开取石术(endoscopic sphincterotomy,EST),其中26例取石成功,11例改行腹腔镜胆总管探查取石术(laparoscopic common bile duct exploration,LCBDE),2例因胆囊炎症重中转开腹。39例患者行LC+LCBDE,其中29例取石成功(6例联合胆道镜下钬激光碎石),6例中转开腹,3例因取石困难术后行EST取石。LCBDE术后发生胆漏3例,腹腔引流8 d痊愈;术后2例T管引流胆道出血,经保守治疗1周内好转。EST术后5例发生黑便,2例血淀粉酶一过性升高,均经保守治疗1周内好转。平均住院(9.4±7.4)d,术后无严重并发症发生。结论:术者应结合个人经验、技术水平及患者病情合理选择微创治疗手段,Oddi括约肌功能完好的患者,LC+LCBDE更能体现微创的真正内涵。
Objective： To investigate the reasonable application of muhi-endoscopic technique on patient with common bile duct calculi and gallbladder calculi. Methods：Seventy-six patients with common bile duct calculi and gallbladder calculi were treated by lap- aroscopic bile duct exploration （LCBDE） plus laparoscopic cholecystectomy （LC） or LC plus endoscopic sphincterotomy （EST）. Clini- cal data were retrospectively analyzed. Results：In the EST ＋ LC group （n =37 ） ,26 cases successfully underwent EST. 11 failed cases with postoperative residual calculus were treated by LCBDE ,2 cases were converted to laparotomy because of severe cholecystitis. In the LCBDE ＋ LC group （ n = 39 ） , 29 cases successfully underwent LCBDE ＋ LC, 6 cases combined with holmium laser lithotripsy under choledoehoscopy,6 cases were converted to laparotomy, and 3 failed cases were treated with EST in the postoperative period. In the LCBDE ＋ LC group ,3 cases developed bile leakage, and were healed after 8 days＇ intraabdominal drainage. 2 cases developed hemobi- lia,were healed after l week＇ s conservative treatment. In the EST ＋ LC group,5 cases developed melena,2 cases developed transient hyperamylasemia, all patients recovered after conservative treatment for l week. Average hospital stay was （9.4 ± 7.4 ） d. No severe postoperative complications occurred. Conclusions ： It is important for the surgeons to select the appropriate mini-invasive endoscopic technique for the patients with common bile duct calculi and gallbladder calculi according to personal experience and technique. For pa- tients with normal Oddi sphincter,LCBDE ＋ LC may be the better choice due to preservation of the function of Oddi sphincter.
出处
《腹腔镜外科杂志》
2014年第11期866-869,共4页
Journal of Laparoscopic Surgery
