三镜术中联合治疗胆囊结石并胆总管结石.docVIP

三镜术中联合治疗胆囊结石并胆总管结石【摘要】目的：研究腹腔镜、胆道镜、十二指肠镜术中联合治疗胆囊结石合并胆总管结石的方法及临床意义。方法：用腹腔镜联合术中胆道镜、十二指肠镜治疗胆囊结石并发胆总管结石45例，在全麻下，行腹腔镜胆囊切除，并切开胆总管前壁，以术中胆道镜联合十二指肠镜取净胆总管结石，一期缝合胆总管，42例并置鼻胆管引流。1例因术中十二指肠镜进镜失败而置入胆道支架。结果：本组45例病例2例中转开腹手术，43例成功，术后5-7天拔管出院，1例术后7天内镜取出支架出院，无手术死亡病例，无术后胆漏，无术后上消化道出血、穿孔及急性胰腺炎发生。结论：腹腔镜联合术中胆道镜、十二指肠镜治疗胆囊结石并发胆总管结石，是一种创伤小，恢复快，减少病员痛苦，安全可靠的方法。 【关键词】腹腔镜；术中联合；胆道镜；十二指肠镜；胆囊结石；胆总管结石 【Abstract】ObjectiveTo investigate the method and it’s clinical significance that treat the common bile duct stone by “tri-scope”: laparoscope combine with cholioscope and duodenoscopeused in operation,. Methods Treat the common bile duct stone by laparoscope combine with cholioscope and duodenoscope used in operation 45 cases. Under general anesthesia ，laparocystectomy was performed first, then open the anterior wall of common bile duct（CBD）, expose CBD by cholioscope and take offthe stones by cholioscope combine with duodenoscope .Then suture the CBD in operation and put in nose bile duct 42 cases,1case put in bracket . Results 2 case turn to open operation.43of 45 cases acquitted succeed andleave hospital after taking off the nose bile duct in 5 to 7 days . 1case take off the bracket by duodenoscope after 7 days. No case die, nobile leaking after operation ,no bleeding and perforation of upper digestive tract ,and no acute pancreatitis after operation. Conclusion Treat the common bile duct stone by laparoscope combine with cholioscope and duodenoscope used in operation is a safe ,effective, and quickly recovering method with less sufferings of the patient and less trauma. 【Key words】Laparoscopecholioscopeduodenoscopecombine in operation common bile duct stone 【中图分类号】R325【文献标识码】B【文章编号】1005-0515(2011)03-0011-01 胆囊结石并发胆总管结石是临床上常见的疾病，传统方法是开腹胆囊切除、胆总管切开取石、T型管引流，创伤大，恢复慢，病员需忍受漫长的T管引流、带管的过程，近年来随着微创外科腔镜技术的发展，已广泛开展腹腔镜联、胆道镜、十二指肠镜技术治疗本病，减少了病员的痛苦[1]，本研究利用腹腔镜联合术中胆道镜、十二指肠镜治疗胆囊结石并发胆总管结石，进一步提高微创治疗的成功率，减少并发症的发生，使三镜治疗本病更加安全可靠，现报告如下。 1 资料与方法 1.1 临床资料：2007年1月至2010年11月期间，我院行腹腔镜联合术中胆道镜、十二指肠镜治疗胆囊结石并发胆总管结石4