三镜联合治疗肝外胆管结石的临床观察.docVIP

三镜联合治疗肝外胆管结石的临床观察 　　摘要：目的 比较腹腔镜胆总管切开取石鼻胆管引流术（LC+LCBDE+ENBD）和内镜逆行性胰胆管造影、十二指肠乳头切开取石后经腹腔镜胆囊切除术（ERCP+EST+LC）两种方法治疗胆总管结石的疗效，探讨腹腔镜胆总管切开取石后鼻胆管引流的优越性。方法 回顾性分析我院于2003年3月～2009年3月103例经腹腔镜胆总管切开取石后胆总管一期缝合鼻胆管引流术和42例行内镜逆行性胰胆管造影、十二指肠乳头切开取石后经腹腔镜胆囊切除术患者的临床资料，在两组住院时间，住院费用及并发症等方面进行对比分析。结果 103例患者成功完成腹腔镜胆总管探查后胆管一期缝合术中置鼻胆管引流术，LC+LCBDE+ENBD组患者住院时间较ERCP+EST+LC组短，住院总费用少，差异有显著性（P0.05），LC+LCBDE+ENBD组患者手术并发症也明显减少。结论 腹腔镜胆总管切开取石后鼻胆管引流术既能缩短了患者治疗疗程，也减轻了患者经济负担，手术并发症也明显减少，是一种安全实用的手术方法。 　　关键词：腹腔镜胆总管切开取石术；鼻胆管引流；胆道镜 　　Abstract：Objective To study the safety and advangtages of laparoscopy ，electronic choledochoscopy combinatde with duodenoscopy for treating the cholecystolithasis associated with choledocholithiasis. Methods From March 2003 to March 2009， 103 patients underwent laparoscopic cholecystectomy， choledochotomy and choledocoscopic cholelithotomy combinated with endoscopic naso-bilian drainage， then the common bile duct was interruptedly sutured after confirmation of no residual stones. Their clinic data， expenses， complication and duration of hospitalization twere compare with those of 42 patients underwent endoscopic nasobiliary duct placement before the operation. Results The clinical outcomes in experimental groups were significantly better than those of control group. And their expenses and the rates of complication of postoperative were lower than those of control group （P0.05）. Conclusion This procedure is a safe a economical nd method which can prevent occurrence of bile leakage and reduce complications. 　　Key words：Laparoscopic common bile duct exploration；Endoscopic biliary drainage； Biliary tract 　　针对胆囊合并胆总管结石的微创治疗方式仍是一个值得探索的领域。随着腹腔镜、胆道镜、电子十二指肠镜技术的完善和发展，“三镜”（腹腔镜、十二指肠镜、胆道镜）联合应用开创了胆总管结石微创治疗的新途径。本文回顾性分析我院2003年3月～2009年3月经微创治疗的145例胆总管结石患者的临床资料，其中103例采用腹腔镜胆总管切开取石鼻胆管引流术（Laparoscopic cholecystectomy and laparoscopic common bilc duct exploration and endoscopic nasobiliary drainage，LC+LCBDE+ENBD），42例采用内镜逆行性胰胆管造影、十二指肠乳头切开取石后经腹腔镜胆囊切除术（Endoscopic retrograde cholangiopancreatography and End