内镜微创保胆联合十二指肠镜乳头扩张取石在胆囊结石并胆总管结石的临床应用

摘要

[ Objective ] To study the therapeutic effect of combined use of endoscopic retrograde cholangiopan-creatography(ERCP)and cholecystolithotomy with gallbladder preserved for cholecystolithias associated with eheledo-cholithiasis. [ Methods ] 54 cases of preoperative diagnosis of common bile ductstones and gallbladder stones in patients after the first treatment of perioperative ERCF, days later, cholecystolithotomy with gallbladder preserved treatment was given. Then the surgical success rate and complications were observed. [Results] ERCP was performed in these cases with the stone clearance rate of 98.1% (53/54). Endoscopic nasobiliary drainage (ENBD) was given after endoscopic sphincterotomy (EST). All the patients were given intraoperative gallbladder-cholangiography (IOC) during endoscopic invasive cholecystolithotomy with gallbladder preserved, hyperamylesemia occurred in 8 cases. All complications were cured with nonoperating treatment. Operations were performed in 1 ease because of periampullary diverticula. [Conclusion] The method of cholecystolithotomy combined with gallbladder preserved and ERCP, in cholecystolithiaswith choledocholithiasis, can give good therapeutic results and has advantages of minimal invasiveness, few complications and quick recovery.%目的 探讨内镜微创保胆术联合十二指肠乳头扩张取石术治疗胆囊胆总管结石的临床效果.方法 选择54例胆囊结石合并胆总管结石患者,先在十二指肠镜下行乳头扩张取石,第3天实施腹腔镜微创保胆取石,统计两镜联合治疗成功情况、并发症及住院时间.结果 53例成功地在十二指肠镜下取出胆总管结石,EST处理胆总管结石并放置鼻胆引流管,在保胆术中经管行胆道造影,8例患者术后出现血淀粉酶升高,经抑酶治疗3～5d后恢复正常,无胆管炎、穿孔及出血等并发症,第3天均在全身麻醉下实施了腹腔镜保胆取石,无1例发生并发症,住院时间5～8d,术后随访未见胆管结石及胆管炎发生.1例因十二指肠乳头旁憩室插管困难取石失败而改腹腔镜保胆取石、胆总管切口取石术.结论 腹腔镜胆囊切除术与内镜括约肌扩张取石术联合治疗胆囊胆总管结石是一种安全有效的新兴治疗方法.