目的总结腹腔镜、胆道镜和十二指肠镜联合治疗急性胆管炎合并胆总管结石、胆囊结石高龄患者的应用经验。方法我院自2007年1月～2014年12月三镜联合治疗急性胆管炎并胆总管结石、胆囊结石的高龄患者86例。首先经十二指肠镜治疗，待病情缓解后，根据患者的身体条件和局部结石情况，分别行腹腔镜胆囊切除术或腹腔镜胆囊切除+胆总管切开、胆道镜胆道探查取石术。结果所有病例均治疗成功，无死亡病例。首次急诊内镜取净结石10例，后行胆囊切除术；76例行三镜联合胆囊切除+胆总管探查术，其中中转开腹手术5例。无严重并发症发生。结论联合腹腔镜、十二指肠镜和胆道镜治疗急性胆管炎合并胆管结石、胆囊结石高龄患者是可行的，临床疗效可靠，创伤小，并发症少，恢复快。%Objective Summarize the experience of laparoscopic and choledochoscopy and duodenoscopy combined treatment experience in the application of acute cholangitis in patients with bile duct stones, gallbladder stones in elderly patients. Methods 86 cases of elderly patients with acute cholangitis and common bile duct stones, gallbladder stones were treated in our hospital from January 2007 to December 2014. First the duodenum mirror treatment, after being remission, according to the patient's body condition and the local stone, laparoscopic cholecystectomy or laparoscopic gallbladder excision respectively and common bile duct incision and choledochoscope biliary exploration nephrolithotomy. Results All cases were treated successfully, no deaths. 10 cases of emergency endoscopy in net stone, for the ifrst time after cholecystectomy, 76 three mirror joint gall bladder resection and common bile duct exploration, the transfer laparotomy in 5 cases. No serious complications occurred. Conclusion Combined laparoscopic and duodenum mirror and choledochoscope in treatment of acute cholangitis combined bile duct stones, gallbladder stone of age patients is feasible and reliable clinical curative effect, small trauma, fewer complications, rapid recovery.
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