lcercp联合微创治疗胆囊结石并胆总管结石的临床应用研究.doc

腹腔镜内镜联合微创治疗胆囊结石并胆总管结石的临床应用研究 李世功，吴正奇，王燕林，陈文元，张志镒，梁育川 甘肃省武威肿瘤医院 武威 甘肃733000 摘要 目的：总结应用腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）联合内镜下乳头括约肌切开术（endosopic sphincterectomy,EST）选择性的治疗胆囊结石并胆总管结石的治疗经验。方法： 回顾性分析72例胆囊结石并胆总管结石采用EST和LC。 结果：70例先行EST再行LC手术获得成功，18例结石大于1.5 cm用碎石网篮碎石后取尽结石，1例因胆总管下段结石嵌顿中转开腹，1例因胆总管结石较大用碎石网篮碎石不成功中转开腹。结论：（EST）联合（LC）是治疗胆囊结石并胆总管结石安全、合理、有效的首选微创方法。 关键词：腹腔镜；内镜；胆石病 The clinical application study of minimally invasive treatment cholelithiasis associated with choledocholithiasis with Endoscopy combined with Laparoscopic Li shi-gong,Wu zheng-qi,Wang yan-ling,Chen weng-yuan,Zhang zhi-yi,Liang yu-chan Wuwei Tumor Hospital of Gansu Province WuWei GanSu 733000 【Abstract】 Objective To summarize the treatment experience of selective treatment cholecystol- ithiasis associated with common bile duct stone with laparoscopic cholecystectomy (LC) combined with endoscopic sphincterectomy(EST). Methods Retrospective analysis 72 cases of choledocholithiasis associated with common bile duct stone patients which were operated with EST and LC.Results 70 cases of first EST then LC were successful,18 patients with larger than 1.5 cm stones were removed with the stone basket after crushed ,1 case of common bile duct stone impacted by laparotomy,another patient with large common bile duct stone because of stone basket unsuccessful was laparotomy.Conclusion EST united LC is the safe ,reasonable ,effective ,minimally invasive and first choice method of treatment cholecystolithiasis associated with common bile duct stone. 【Key words】 Laparoscope; Endoscope; Cholelithiasis 1.1临床资料 胆囊、胆总管结石共72例，其中男性40例，女性32例，年龄28~79岁，平均51.5岁。既往右上腹部疼痛，发热，黄疸或胰腺炎史，术前经B超或逆行胰胆管造影术（endoscopic retrograde cholangio pancreatography,ERCP）证实胆囊、胆总管均有结石。胆囊结石直径0.5-3.0cm，1枚或多枚，胆总管结??1.0-3.0cm，数目1-7枚，本院患者术前诊断：急性胆囊炎胆囊结石合并胆总管结石16例, 慢性胆囊炎胆囊结石合并胆总管结石56例,72例病人均无肝内胆管结石，均有不同程度的胆红素和碱性磷酸酶升高，无上腹部手术史。先行EST,用电子十二指肠镜为择期手术患者中有合并胆总管结石者行逆行胰胆管造影术（ERCP），经内窥镜行Oddi括约肌切开术（EST）和球囊或网篮取石术，结石较大者用碎石网篮碎石后再取出。3—5天后行腹腔