ERCP联合腹腔镜治疗胆囊结石伴胆道病变临床应用.docVIP

ERCP联合腹腔镜治疗胆囊结石伴胆道病变临床应用 　 作者：王建平，苏进根，陆弈宁，杨廷燕，龚彪 【摘要】 目的 探讨逆行胰胆管造影术（ERCP）联合腹腔镜胆囊切除术（LC）对胆囊结石伴胆管病变治疗的临床应用。方法 27例胆囊结石伴胆道病变患者，先用ERCP、乳头切开术（EST）取石；或ERCP和鼻胆管引流（ENBD）及柱状气囊扩张术（EPBD）治疗，术后3～11天，患者无发热、腹痛，血淀粉酶正常，再按常规四孔法施行LC。结果 26/27例（96.3%）成功完成ERCP术。18例行EST术，1例用EPBD，5例置ENBD，2例仅造影诊断。15例胆总管结石全部取尽。25例病人完成LC术，2例开腹手术。2/27例（7.4%）ERCP术后急性轻型胰腺炎，无LC和EST相关并发症。结论 ERCP联合腹腔镜对胆囊结石伴胆管病变的治疗，符合外科微创诊治理念，是外科微创术式的可靠选择。 　　【关键词】 腹腔镜胆囊切除术；逆行胰胆管造影术；胆囊结石；胆管病变 　　The clinical application of the ERCP combined with laparoscopic cholecystectomy for treatment of the cholecystic stone concomitant with bile duct disease:a report of 27 cases 　　【Abstract】 Objective To explore clinic application of endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy (LC) for the treatment of the cholecystic stone combined bile duct disease.Methods 27 patients with cholecystic stone concomitant with bile duct disease were extracted firstly all stones or placed nasobiliary catheter in the bile duct or given endoscopic papillary balloon dilatation (EPBD) by the ERCP.After 3 to 11 days through ERCP,the patients performed LC when they had not fiver,abdominal pain and serum amylase was normal.Results 26 cases had performed successfully ERCP in 27 patients (96.3%),which of 18 cases were given EST,1 patient used EPBD and 5 cases placed ENBD,another 2 patients given only diagnostic ERCP.15 cases of stone in the common bile duct were excluded completely.25 patients were performed by LC and 2 cases selected by surgical cholecystectomy after ERCP.There were complications with acute pancreatitis in 2 cases (7.7%),that be cured by medication and not complication with LC or EST.Conclusion ERCP combined with LC for treatment of the cholecystic stone concomitant with bile duct disease in accordance with a modern conception of the surgical treatment with mini-damage,it will be credible selection of the surgical manner with mini-damage. 　　【Key words】 laparoscopic cholecystectomy;endoscopic retrograde ch