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腹腔镜联合胆道镜、十二指肠镜治疗胆囊结石合并肝内外胆管结石的效果观察
Clinical application of laparoscopy combined with choledochoscopy and duodenoscopy in treatment of gallstones complicated by intra- and extrahepatic bile duct stones
文章发布日期:2016年05月06日  来源:  作者:温治强, 宋越, 张耀明, 等  点击次数:1009次  下载次数:235次

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【摘要】:目的总结应用腹腔镜联合十二指肠镜、胆道镜对胆囊结石合并肝内外胆管结石患者的治疗经验及疗效。方法收集2010年3月-2015年3月于梅州市人民医院肝胆外科就诊的胆囊结石合并肝内外胆管结石患者413 例,根据患者个体情况分别进行腹腔镜、胆道镜、十二指肠镜“二镜”或“三镜”联合治疗。 结果腹腔镜胆囊切除术(LC)+胆道镜经胆囊管胆总管探查取石术(LTCBDE)31例,成功率29.0%(9/31);LC+LCBDE+胆道镜取石术+T管引流术101例,成功率93.1%(94/101); LC+胆总管探查术(LCBDE)+胆道镜取石术+Ⅰ期缝合术96例,成功率97.9%(94/96);LC+LCBDE+肝部分切除术 61例,成功率91.8%(56/61);十二指肠乳头括约肌切开术(EST)+LC或LC+EST 155例,成功率93.5%(145/155);腹腔镜+十二指肠镜+胆道镜(同时)10例,成功率90%(9/10)。19例患者中转开腹,治疗总成功率95.4%(394/413),各组病例均治愈,无严重并发症,无死亡病例。 结论腹腔镜联合胆道镜、十二指肠镜治疗胆囊结石合并肝内外胆管结石是切实可行和安全可靠的。
【Abstract】:Abstract:ObjectiveTo summarize the experience in laparoscopy combined with choledochoscopy and duodenoscopy in the treatment of gallstones complicated by intra- and extrahepatic bile duct stones, and to investigate its therapeutic effect. MethodsA total of 413 patients with gallstones complicated by intra- and extrahepatic bile duct stones who visited Meizhou People′s Hospital from March 2010 to March 2015 were enrolled, and according to the patients′ individual conditions, they were given laparoscopy combined with choledochoscopy and/or duodenoscopy. ResultsA total of 31 patients underwent laparoscopic cholecystectomy (LC)+laparoscopic transcystic common bile duct exploration (LTCBDE), and the success rate was 29.0% (9/31); 101 patients underwent LC+LTCBDE+T tube drainage, and the success rate was 93.1% (94/101); 96 patients underwent LC+laparoscopic common bile duct exploration (LCBDE)+choledochoscopic cholecystolithotomy+primary suture, and the success rate was 97.9% (94/96); 61 patients underwent LC+LCBDE+partial hepatectomy, and the success rate was 91.8% (56/61); 155 patients underwent endoscopic sphincterotomy (EST)+LC or LC+EST, and the success rate was 93.5% (145/155); 10 patients underwent laparoscopy+duodenoscopy+choledochoscopy (at the same time), and the success rate was 90%(9/10). Nineteen patients were converted to open surgery, and the overall success rate was 95.4%(394/413). All the patients were cured, and there were no serious complications or deaths. ConclusionLaparoscopy combined with duodenoscopy and choledochoscopy is feasible, safe, and reliable in the treatment of gallstones complicated by intra- and extrahepatic bile duct stones.
【关键字】:胆道疾病;腹腔镜;十二指肠镜;胆道镜
【Key words】:biliary tract diseases; laparoscopes; duodenoscopes; choledochoscopes
【引证本文】:温治强, 宋越, 张耀明, 等. 腹腔镜联合胆道镜、十二指肠镜治疗胆囊结石合并肝内外胆管结石的效果观察[J]. 临床肝胆病杂志, 2016, 32(6): 1145-1148.

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