胆囊合并胆总管结石的诊治体会.docVIP

胆囊合并胆总管结石的诊治体会 2007-4-3 2007年第11卷第3期A版任秋英 （北京市平谷区医院，北京? 101200） 【摘要】? 目的??? 探讨现代外科对胆囊合并胆总管结石的诊治方法。方法??? 13年来我院对262例病人在准备行腹腔镜胆囊切除术前行ERCP或MRCP检查。其指征为：近期有胰腺炎发生或黄疸史，肝功能异常，B超或CT示胆总管扩张或有结石者。结果??? 在此262例中，有257例发现结石并行EST或网篮取石成功，待胆总管恢复正常后行腹腔镜胆囊切除术。23例发现乳头狭窄或胆总管肿瘤，行EST、支架内引流或手术治疗。12例ERCP失败。结论??? 胆囊合并胆总管结石的治疗策略为术前先行ERCP或MRCP+EST，取石成功后再行LC为最佳策略。 【关键词】? 胆囊合并胆总管结石??? 腹腔镜胆囊切除术??? 内窥镜??? MRCP The diagnosis and treatment of cholecy-stolithiasis combined with choledocholithiasis Ren Qiuying. Pinggu district hospital of Beijing?? (Beijing 101200)? 【Abstract】? Objective??? To investigate the modern surgical method to diagnose and treat the cholecy-stolithiasis with choledocholithiasis.? Methods??? We have done ERCP or MRCP to? 262 patients before the LC since 13 years ago.The indications were that had pancreatitis recently , had the history of jaundice , disfunction of Hepar or B-ultrasound or CT showd? choledochectasia or cholecystolithiasis with choledocholithiasis. Results??? In the 262 cases， there were 257 cases with gallstone and received the EST or? removed? stone by basket successfully.? Then? they received the LC until the choledochus recovered. 23 cases were? found stegnosis of duodenal papilla or choledochus tumor，and received the theatment of EST, internal drainage or surgery. 12 cases of ERCP failed. Conclusion??? ERCP or MRCP+EST should be carried out cholecy-stolithiasis combined with choledocholithiasis is doing to remove the gollstone and then doing the LC. 【Key Words】? The cholecy-stolithiasis with choledocholithiasis??? LC??? Endoscope ? 目前，腹腔镜胆囊切除术（LC）由于具有微创特点及良好效果，已经为治疗单纯胆囊结石的标准术式。腹腔镜外科发展之后，胆总管结石的治疗方法多样化，而微创外科方法同样受到重视，因为微创可以使病人少受痛苦而达到良好的治疗效果。我院从1992年就开展了腹腔镜胆囊切除术，十几年来我院先后对227例患者联合应用ERCP、EST及LC治疗胆囊合并胆总管结石取得良好效果。近几年来，我院引入了核磁大型检查仪器，MRCP图像清晰，对胆总管结石有较高的诊断价值，并具有无创、无禁忌证等优点，其准确性可达到92%~96%[1]。 1??? 临床治疗 1.1??? 一般资料??? 本组男84例，女143例，年龄26岁~74岁，平均50.4岁。本组病人都具有下列条件之一：近期有胰腺炎发生或黄疸史，肝功能异常，B超或CT示胆总管轻、中度扩张或结石；胆囊内有多发性小结石伴胆管扩张。 1.2??? 治疗方法??? 262例均行ERCP或MRCP检查，227例发现胆总管结石，行EST或网篮碎石、