双镜联合同期治疗胆囊结石合并胆总管结石的策略

Strategy of laparoscopy and choledochoscopy or duodenoscopy for the treatment of cholecystolithiasis combined with choledocholithiasis

  • 摘要: 胆囊结石合并胆总管结石是一种常见、多发疾病,近年来传统的开腹手术受到微创手术挑战。近年通过全面分析和总结胆囊结石合并胆总管结石的微创治疗现状,发现双镜联合同期治疗的微创手术成为主流:对于胆总管不扩张(直径<0.8 cm)的胆囊结石合并胆总管结石患者,首选LC联合内镜乳头括约肌切开(EST)或经内镜十二指肠乳头气囊扩张术(EPBD),条件具备时可选用LC联合胆道镜经胆囊管胆总管结石取石术。对于胆总管扩张(直径>0.8 cm)的胆囊结石合并胆总管结石患者,首选LC联合胆道镜胆总管切开取石、T管引流术,如果胆总管结石已取尽、胆总管下端通畅、Oddi括约肌功能良好,可行胆总管一期缝合。术者合理选择双镜联合的微创手术方案,对于提高胆囊结石合并胆总管结石的治疗效果、避免术后并发症或隐患具有重要的临床意义。

     

    Abstract: Cholecystolithiasis combined with choledocholithiasis is a common disease. The typical open surgery is challenged by the minimally invasive surgery recently. The minimally invasive surgery combined with laparoscopy and choledochoscopy or duodenoscopy has been accepted widely through analyzing and summarizing comprehensively the current situation of the minimally invasive surgery for cholecystolithiasis combined with choledocholithiasis. Laparoscopic cholecystectomy (LC)+endoscopic sphincterotomy (EST) or endoscopic papillary balloon dilation (EPBD) should be chosen primarily for the patients with cholecystolithiasis combined with choledocholithiasis and without common bile duct dilatation (common bile duct diameter<0.8 cm), and LC+laparoscopic transcystic common bile duct exploration and lithotomy are used under favorable conditions. LC+choledocholithotomy or T tube drainage should be chosen primarily for the patients with cholecystolithiasis combined with choledocholithiasis and common bile duct dilatation (common bile duct diameter>0.8 cm). Primary suture of common bile duct should be used with removal of the common bile duct stones, patency of distal common bile duct and recovery function of sphincter of Oddi. The minimally invasive surgery combined with laparoscopy and choledochoscopy or duodenoscopy which is selected reasonably could improve the treatment of cholecystolithiasis combined with choledocholithiasis and reduce the complications,with a significant clinical efficacy.

     

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