胆囊结石合并胆管结石微创治疗方案的选择.doc

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1、胆囊结石合并胆管结石微创治疗方案的选择【摘要】目的探讨胆囊结石合并继发胆道结石微创治疗的合理方案。方法108例胆囊结石合并可疑胆道继发结石均行腹腔镜胆囊切除术（laparoscopiccholecystectomy，LC），其中腹腔镜联合胆道镜经胆囊管胆道探查取石（laparoscopictranscycticcommonbileductexploration，LTCBDE）+LC70例，腹腔镜联合胆道镜胆总管切开胆道取石（laparoscopiccommonbileductexploration，LCBDE）+LC35例，其中放T管14例，不放T管21例，内

2、镜乳头肌切开术(endoscopicsphincterotomy，EST)术后行胆囊切除3例。结果LCBDE+LC术后放T管组中有1例胆漏经保守治疗治愈，4例术后胆道造影发现胆道残余结石经胆道镜取出结石治愈，其他病例无胆漏，术后3月复查B超无残余胆道结石，所有病例术后无胰腺炎发作。结论在胆囊结石继发胆道结石的治疗中合理选择多种微创手术方法能降低创伤及减少并发症的发生。【关键词】胆囊结石病胆管结石胆囊切除术腹腔镜Selectionofprojectofminimalinvasiveoperationsingallstoneswithcholedocholithi

3、asisAbstractObjectiveTostudythesuitableminimalinvasivemethodstotreatthegallstoneswithsecondarycholedocholithiasis.MethodsThecholedocholithiasis，choledochectasiaorcombinedwithjaundicewerefoundin108casesofgallstones.Allthesepatientsweredividedintofourgroupsaccordingtotheresultsoftheex

4、aminationbeforeoperation：①Laparoscopiccholecystectomy(LC)wasperformedingallstonesonly.②LC+laparoscopictranscycticcommonbileductexploration(LTCBDE)wereperformedingallstonescombinedcholedocholithiasiswithcysticdilation.NoTtubedrainagewasused.③LC+laparoscopiccommonbileductexploration(L

5、CBDE)wasperformedingallstonescombinedcholedocholithiasiswithnocysticdilation.CommonbileductwassuturedintimewithoutTtubedrainageinthosewithafewstones.Otherwise，Ttubedrainagewasperformedinthosehavingmorestonesandedemaattheendofcommonbileduct.④Endoscopicsphinctectomy(EST)wasperformedin

6、theagemorethan80yearsoldpatientsorhavingseriousheartorlungsdisorders，LCwasperformedonemonthafterEST.ResultsLCwasperformedinall108cases.LTCBDE+LC70case，LCBDE+LC35cases，Ttubedrainagein14cases，21caseswithoutTtubedrainage，ESTwereperformedin3cases.BileleakagewasfoundinonecaseinLCBDE+LC.S

7、tonesremainedincommonbileductafteroperationin4casesinLCBDE+LC.Nopancreatitiswasfoundinallpatients.ConclusionThedamageandcomplicationswillbereducedin4gallstonecombinedwithcholedocholithiasisifthesuitableminimalinvasivesurgerytechniqueischosen.Keywordscholecystolithiasis；calculusofbil

8、educt；cholecystecto