3镜联合同期治疗内镜取石失败的胆道结石

Synchronous treatment of combined choledochoscopy, duodenoscopy and laparoscopy for management-failed biliary calculi

摘要:

目的  总结应用腹腔镜、胆道镜、十二指肠镜（3镜），胆总管一期缝合，同期治疗内镜取石失败的胆囊结石合并胆管结石的治疗经验。方法  回顾性分析该院2013年6月-2015年6月25例胆囊结石合并胆总管结石患者，在经内镜逆行胰胆管造影术（ERCP）插管成功，取石失败后同期行腹腔镜下胆囊切除、胆总管切开、胆道镜取石和液电碎石，一期缝合胆总管切口的手术疗效。结果  1例患者中转辅助小切口取石，1例术后残余结石行ERCP取石。术后2例出现一过性淀粉酶升高，经保守治疗后痊愈；1例出现胆瘘，经腹腔引流管引流痊愈；无严重并发症及死亡。随访至今无发现结石复发或胆道狭窄。结论  对于内镜取石失败患者，严格把握适应证，采用3镜联合胆总管一期缝合同期治疗是可行、有效和安全的。

Abstract:

 Objective To summarize the experience of applying choledochoscopy, duodenoscopy and laparoscopy, one-stage suturing of common bile duct, to treat cholecystolithiasis and choledocholithiasis that failed to respond to ordinary endoscopic sphincterotomy (EST). Methods Retrospectively analyzed the clinical data of twenty-five patients with choledocholithiasis complicated with cholecystolithiasis. 25 cases of failure to endoscopic stone extraction underwent LC and laparoscopic common bile duct exploration with primary suture of (BD) from June 2013 to June 2015. Results One patient was converted to laparotomy with small incision. The other one had residual stones and therefore underwent a second EST. After the treatment, two patients developed hyperamylasemia, which was cured by conservative therapy; One patient had bile leakage, which was treated by percutaneous drainage with no serious complications and death. No long-term complication was found in a portion of patients followed up until now. Conclusion In properly selected patients of duodenoscopy management-failed, synchronous treatment of combined application of three endoscopies in laparoscopic surgery with primary suture of (BD) is feasible, effective and safe.