联合应用腹腔镜胆囊切除术和十二指肠乳头括约肌切开术治疗胆囊、胆总管结石(一)

详细内容

作者：张扬，黎有典，唐佳新，张克兰，陈能志，李斌，赵凯，龚克

【摘要】目的：总结腹腔镜胆囊切除术＋十二指肠乳头括约肌切开术（ＬＣ＋ＥＳＴ）治疗胆囊、胆总管结石的体会。方法：为６例患者行ＬＣ＋ＥＳＴ。结果：本组病例均在术前行Ｂ超检查及ＭＲＣＰ检查，诊断为胆囊结石及胆总管结石，行ＬＣ＋ＥＳＴ均获成功。手术顺利，无胆管并发症。结论：与传统的胆囊切除，胆道探查、取石，Ｔ管引流，或术中经胆囊管造影后探查胆总管以及行腹腔镜胆总管探查取石术（ＬＣＢＤＥ）比较，经Ｔ管窦道行胆道镜取石，患者创伤小，痛苦轻，康复快。

　　【关键词】胆总管结石；胆囊切除术，腹腔镜；十二指肠括约肌切开术

　　Laparoscopic cholecystectomy bined with endoscopic sphincterotomy in treating cholecystolithiasis and choledocholithiasis

　　　【Abstract】Ｏbjective:To observe the clinical results of LC bined with EST in treating cholecystolithiasis and choledocholithiasis.Methods:The clinical data of 6 cases that received LC bined with EST herapy for cholecystolithiasis and choledocholithiasis were analyzed retrospectively.Results:The preoperative diagnosis were all confirmed by the results of ultrasound and MRCP,all the cases were operated suessfully without ourrence of biliary plications.Conclusions:pared with those orthodox methods,LC bined with EST procedure contains the advantages of minor trauma,quick recovery and definite therapeutic results.

　　【Key words】Choledocholithiasis;Cholecystectomy,laparoscopic;Endoscopic sphincterotomy

　　我院在开展腹腔镜胆囊切除术(ＬＣ)和十二指肠乳头括约肌切开术（ＥＳＴ）的基础上，２００２年１０月至２００５年６月联合应用ＬＣ和ＥＳＴ治疗胆囊结石、胆总管结石６例，取得满意效果，现报道如下。

　　１资料与方法

　　１１临床资料

　　本组患者６例中男４例，女２例，３０～５７岁，平均４３６岁。４例术前伴有黄疸及胆管炎，另２例为慢性结石性胆囊炎，胆绞痛症状反复发作。４例行Ｂ超及ＭＲＣＰ（磁共振胆道水成像）示胆囊结石及肝外胆管结石，２例Ｂ超检查示胆囊结石，胆总管扩张，无黄疸。６例均为胆囊结石、继发性胆总管结石，胆总管原发结石的患者。

　　１２治疗方法

　　６例均无重症胆管炎表现及血尿淀粉酶增高。术前３０min均皮下注射善宁０１mg行ＥＲＣＰ，结石后立即行ＥＳＴ。术后观察腹部体征和血尿淀粉酶变化，按常规应用或预防性应用抗生素及抑胰酶药物，２～４d后行ＬＣ。

　　２ 结果

　　本组６例均在术前Ｂ超检查及ＭＲＣＰ检查诊断为胆囊结石及胆总管结石，行ＬＣ＋ＥＳＴ均获成功。ＬＣ手术顺利，无胆管损伤出血等并发症。ＥＳＴ术中均用取石篮套取结石。２例ＥＳＴ术后并发一过性血清淀粉酶增高，禁食，应用生长抑素、制酸剂及预防性抗生素，２d后恢复正常。１例行ＥＳＴ时切开处有渗血，经局部应用去甲肾上腺素盐水冲洗止血。