内镜逆行胰胆管造影术取石失败后即行腹腔镜胆总管探查术的临床观察

Clinical observation of early laparoscopic common bile duct exploration continue to failed endoscopic bile duct stone extraction

摘要:

 目的   对于胆囊结石合并肝外胆管结石患者，探讨内镜逆行胰胆管造影术（ERCP）治疗肝外胆管结石不成功时如何选择治疗方式及时机。方法  12例胆囊结石合并肝外胆管结石拟分期行腹腔镜胆囊切除术（LC）+ERCP患者，行常规ERCP治疗失败，立即静吸复合全麻下完成LC+胆管探查取石术（LCBDE）。结果 12例患者均顺利完成LC+LCBDE，并取净结石。术后3例出现高淀粉血症，全组无胆漏、肠漏、胆管炎、胰腺炎和胆道出血等并发症发生。结论 对于ERCP治疗不成功的患者，急诊行LCBDE是安全、可行的补救措施。

   

Abstract:

Objective To discuss the treatment method and opportunity for patients with gallbladder stones and extrahepatic bile duct stones who failed endoscopic removal of common bile duct stones by endoscopic retrograde cholangiopancreaticography (ERCP). Methods 12 patients, with gallbladder stones and extrahepatic bile duct stones, failed endoscopic stone extraction (ESE), underwent emergency one-stage laparoscopic cholecystectomy (LC) and Laparoscopic common bile duct exploration (LCBDE). Results All of the patients were successfully completed LC + LCBDE and stones were completely removed. Hyperamylasemia occurred in 3 cases and there was no bile leakage, intestinal leakage, cholangitis, pancreatitis, biliary bleeding and other complications. Conclusions Emergency LCBDE has been shown to be a safe and effective salvage procedure for failed ESE.