【摘要】 目的探讨应用腹腔镜、十二指肠镜、胆道镜三镜共七种方法治疗肝外胆道结石的价值与相互关系。方法回顾性分析2002年6月~2006年6月采用"三镜七法"治疗246例肝外胆道结石的临床资料。腹腔镜法(Ⅰa)8例,十二指肠镜法(Ⅰb)27例,胆道镜法(Ⅰc)17例,腹腔镜+胆道镜法(Ⅱa)83例(含转入9例),腹腔镜+十二指肠镜法(Ⅱb)102例,胆道镜+十二指肠镜法(Ⅱc)3例(均为转入),三镜联合法(Ⅲ)21例(含转入3例)。结果各种方法成功率在82%~100%,无重大并发症。胆道残留结石10例均再次取石成功。202例随访3个月~4年,平均25.6月,未发现胆道狭窄,15例结石复发。结论"三镜七法"丰富了微创治疗方案,"七法"治疗各有特点,应"优先一镜,重点应用二镜,合理应用三镜"。更多还原

【Abstract】 Objective To evaluate values of laparoscope,duodenoscope,choledochoscope and seven procedures for extrahepatic biliary calculi.Methods From Junuary 2002 to June 2006,clinical data of 246 cases of extrahepatic biliary calculi treated by three kinds of endoscope and seven procedures were reviewed retrospectively.Laparoscope(Ⅰa) was used in 8 cases,duodenoscope(Ⅰb) in 27 cases,choledochoscope(Ⅰc) in 17 cases,laparoscope combined with choledochoscope(Ⅱa) in 83 cases(including transferred 9 cases),laparoscope combined with duodenoscope(Ⅱb) in 102 cases,choledochoscope combined with duodenoscope(Ⅱc) in 3 cases(all transferred),combined three kinds of endoscope(Ⅲ) in 21 cases(containing transferred 3 cases).Results The success rate of all procedures was 82%-100% without severe complications.Residual stones in biliary tracts were removed once again successfully in 10 cases.The mean of follow-up period was 25.6 months(range,3 months to 4 years).No biliary tract stenosis was observed in 202 cases and stone recurred in 15 cases.Conclusions Three kinds of endoscope and seven procedures supplement minimally invasive treatment.As seven procedures have different indications respectively,the principle "one endoscope preference,main application of two endoscopes,and reasonable application of three endoscopes" should be followed.更多还原