【摘要】 目的总结腹腔镜联合纤维胆道镜和十二指肠镜、胆道造影治疗肝外胆管结石的效果。方法回顾性分析123例肝外胆管结石合并(或不合并)胆囊结石患者经内镜联合腹腔镜治疗的临床资料。结果123例ERCP全部成功,EST操作成功率97.6%(120/123),9例(7.5%)EST后并发急性胰腺炎,42例(35.0%)术后一过性血淀粉酶升高,23例(19.1%)EST后胆红素较术前轻度升高,均经保守治疗痊愈。EST术后LC成功48例,术中胆道镜取石16例,术中胆道造影11例,1例中转开腹无严重并发症。1例患者EST术中出现十二指肠穿孔。LC术中胆道造影发现EST术后胆总管残余结石1例,胆管变异3例,EST联合LC、胆道镜治疗结石成功率96.7%(119/123)。结论LC联合EST、胆道镜、胆道造影能成功治疗肝外胆管结石,具有微创、效果好、恢复快等优点。更多还原

【Abstract】 【Objective】To study the effect of combined endoscopy and cholangiography with laparoscopic mini- invasived management for cholelithiasis. 【Method】Clinical data of 114 cases of cholelithiasis treated by combined endoscopy and laparoscopy were retrospectively reviewed. 【Results】123 cases included male 29 and female 94. All patients underwent ERCP successfully, and EST were successful in 120 patients (97.6%). After EST, 9 patients complicated with acute pancreatitis, 42 with increased hemodiastase for short time, 23 with increased bilirubin light- ly. LC were operated in 48 cases, including fibercholangioscopy for the treatment of cholelithiasis in 16 patients and cholangiography in 11 patients. 1 patients were converted to laparotomy without severe complications. 1 patient suf- fered the complication of duodenum perforation. Common duct stone was diagnosed by cholangiography in 1 patient and variated biliary duct in 3 patients after EST. Treatment of EST combined with laparoscopic cholecystectomy and fibercholangioscopy has a high achievement ratio (119/123, 96.7%) for cholelithiasis. 【Conclusion】In management for cholelithiasis, laparoscopic cholecystectomy combined with EST, fibercholangioscopy and cholangiography has many advantages, such as minor damage, rapid recovery and better result.更多还原