胆囊结石合并细径胆总管小结石的临床治疗分析

【摘要】 目的 探讨腹腔镜胆囊切除（LC）联合补救性内镜逆行胰胆管造影（ERCP）球囊扩张取石术治疗胆囊结石合并细径胆总管小结石的安全性和可行性。方法 回顾性分析本院2018年4月至2022年12月期间普外科收治的36例胆囊结石合并细径胆总管小结石并单纯行LC患者的临床资料，随访其后续胆总管结石排出情况，对胆总管小结石滞留患者行补救性ERCP球囊扩张取石术。结果 共纳入36例胆囊结石合并细径胆总管小结石的患者，其中男15例，女21例；年龄27～59岁，平均年龄41.3岁。术前影像学提示胆总管直径均≤7 mm，胆总管内结石直径≤6 mm，手术均予以单纯行LC，术后出现腹痛5例、腹痛合并黄疸4例，出院后1个月内复查影像证实胆总管结石自行排出者29例（80.5%），未自行排出者7例（19.4%）,7例未自行排出者均予以行补救性ERCP球囊扩张取石术，其中6例取石顺利，1例取石失败。所有患者均恢复顺利，出院后平均随访6个月，未见胆道狭窄、胆管炎等并发症。结论 LC联合补救性ERCP球囊扩张取石治疗胆囊结石合并细径胆总管小结石是安全可行的，可减少不必要的胆总管有创干预。更多还原

【Abstract】 Objective To investigate the safety and feasibility of laparoscopic cholecystectomy(LC) combined with remedial endoscopic retrograde cholangiopancreatography(ERCP) balloon dilation in the treatment of small diameter choledocholithiasis combined with cholecystolithiasis. Methods The clinical data of 36 patients with small diameter choledocholithiasis combined with cholecystolithiasis who underwent LC in our hospital from April 2018and December 2022 were retrospectively analyzed, the discharge of choledocholithiasis was followed up, and the patients with choledocholithiasis retained underwent remedial ERCP balloon dilation. Results A total of 36 patients with small diameter choledocholithiasis combined with cholecystolithiasis were included, including 15 males and 21 females, with an average age of 41.3 years(range: 27～59), preoperative imaging showed that the diameter of common bile duct was≤7 mm, and the diameter of stones in common bile duct was≤6 mm, all patients underwent LC, postoperative abdominal pain occurred in 5 cases and abdominal pain combined with jaundice in 4 cases, with in 1 month after discharge, 29 cases(80.5%) confirmed that choledocholithiasis were discharged spontaneously, 7 cases(19.4%) were not discharged, all the 7 cases were treated with remedial ERCP balloon dilation, of which 6 cases were successfully and 1 case failed. All patients recovered successfully and were followed up for an average of 6 months after discharge, no complications such as biliary stricture and cholangitis were occured. Conclusion LC combined with remedial ERCP balloon dilation is safe and feasible in the treatment of small diameter choledocholithiasis combined with cholecystolithiasis, it can reduce unnecessary invasive intervention of common bile duct.更多还原