“一步二分类法”治疗胆囊结石合并胆总管结石的可行性

摘要

Objective To study the efficacy and feasibility of the "one-stage and two classification" method to treat concomitant gallbladder stones and common bile duct stones.Methods 56 consecutive patients with concomitant gallbladder stones and common bile duct stones in Central Hospital of Huzhou were treated with the "one-stage and two classification" method from January 2013 to January 2017.According to the size and quantity,common bile duct stones were divided into difficult stones and non difficult stones.In plan A (n =35),endoscopic stone clearance and laparoscopic cholecystectomy were undertaken in a single operation to treat non difficult stones,In plan B (n =21),laparoscopic cholecystectomy and CBD exploration without T-tube insertion were undertaken in a single operation to treat difficult stones.The operation success rate,postoperative complications,hospitalization stay and follow-up outcomes were analyzed.Results Fifty-six patients were enrolled in the study.Fifty-one patients were treated by the "one-stage and two classification" method.Among them,thirty-two patients followed treatment plan A.Three patients were convened to plan B because of failure of bile duet intubation.Nineteen patients were treated by plan B.One patient was converted to laparotomy,and another underwent T-tube drainage.The incidence of complication was 7.1％.Post-ERCP pancreatitis happened in one patient.Post ERCP bleeding happened in another patient (1.6％).Bile leakage occurred in one patient,and incision infection occurred in one patient.There were no deaths.During a follow-up of 6-24 months,no stone recurrence and bile duct stenosis were observed.Conclusion The "one-stage and two classification" method was an effective and feasible alternative to manage concomitant gallbladder stones and common bile duct stones.%目的 探讨“一步二分类法”治疗胆囊结石合并胆总管结石的可行性及疗效.方法 对2013年1月-2017年1月湖州市中心医院收治的56例胆囊结石合并胆总管结石患者,连续采用“一步二分类法”治疗.按胆总管结石大小和数量分为困难结石和非困难结石.非困难结石患者采用术中内镜取石+腹腔镜胆囊切除术治疗(A方案,n=35);困难结石患者采用鼻胆管引流+腹腔镜胆囊切除+胆总管探查取石一期缝合(B方案,n=21).分析患者手术成功率、手术时间、术后并发症发生率、住院时间及随访结果.结果 56例患者中按“一步二分类法”完成手术51例.其中A方案35例患者完成32例,另3例胆管插管失败转为B方案.B方案21例患者完成19例,1例中转开腹手术,1例放置T管引流.A方案患者的手术时间为(46.4±9.8) min,B方案手术时间(78.6±7.0)min.全组患者术后发生并发症4例(7.1％),包括ERCP后胰腺炎、ERCP后出血、胆漏、切口感染各1例.无死亡患者.所有患者均获6～ 24个月的随访,无结石复发和胆道狭窄.结论 “一步二分类法”个体化治疗胆囊结石合并胆总管结石是合理、安全有效的方法.