摘要
目的评价“三镜（腹腔镜、十二指肠镜、胆道镜）联合一步法”治疗胆囊合并胆总管结石的应用价值。方法回顾性分析2015年12月至2106年12月胆囊结石合并胆总管结石患者56例的手术疗效。其中27例患者行腹腔镜＋胆道镜＋十二指肠镜联合行胆囊切除＋胆总管探查I期缝合＋鼻胆管引流术（三镜联合组），29例患者行逆行性胆道造影＋鼻胆管引流＋腹腔镜行胆囊切除术（对照组）。结果56例患者中手术成功切除胆囊并取净胆总管结石55例。三镜联合组中1例因合并肝内胆管结石未能取净，对照组中3例因ERCP置管失败转腹腔镜＋胆总管探查术。术后总并发症率为3．5％，对照组有2例术后发生胰腺炎，经对症处理后好转。无严重并发症及死亡病例。三镜联合组患者住院时间更短。结论三镜联合一步法治疗胆囊结石合并胆总管结石是安全可行的，同时提高患者的生活质量，减少住院时间。
Objective To evaluate the value of a single stage with combined tri-endoscopic （ laparoscopy, duodenoscopy and choledochoscope ） treatment of cholecystolithiasis complicated with common bile duct stones . Methods The surgical efficacy of 56 patients suffering from cholecystolithiasis combined with choledocholithiasis was reviewed and analyzed in our hospital from December 2015 to December 2106. Among them, 27 patients were treated with laparoscopic cholecystectomy, primary suture of common bile duct after exploration and endoscopic nasobiliary drainage cooperated by three kinds of endoscopies （ combined tri-endoscopic group ） . And 29 patients underwent endoscopic retrograde cliolangiopancreatography, endoscopic nasobiliary drainage combined with laparoscopic cholecystectomy （ control group ） . Results 56 cases of patients successfully underwent cholecystectomy, meanwhile removed the common bile duct stones in 55 cases. One patient in the combined tri- endoscopic group failed to get rid of intrahepatic bile duct stones, and three patients in the control group were treated with combined tri-endoscopic because of the failure of ERCP. The total postoperative comphcation rate was 3.5% . 2 patients of the control group had postoperative pancreatitis, who recovered after symptomatic treatment. No serious complications or deaths were occured. The combined tri-endoscopic group had shorter hospital stays. Conclusion The single-stage with combined tri-endoscopic method for the treatment of cholecystolithiasis with choledocholithiasis is safe and feasible. At the same time, it improves the quality of life of patients and reduces the hospitalization time.
出处
《浙江临床医学》
2018年第3期509-510,共2页
Zhejiang Clinical Medical Journal
关键词
三镜联合
胆总管结石
胆总管探查
鼻胆管引流
I期缝合
Combination of three kinds of endoscopies Common bile duct stones Common bile duct exploration Endoscopic nasobiliary drainage Primary suture
