三镜联合治疗肝外胆管结石的临床观察.docx

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（P关键词：腹腔镜胆总管切开取石术；鼻胆管引流；胆道镜Abstract：ObjectiveTostudythesafetyandadvangtagesoflaparoscopyelectroniccholedochoscopycombinatdewithduodenoscopyfortreatingthecholecystolithasisassociatedwithcholedocholithiasis.MethodsFromMarch2003toMarch2009103patientsunderwentlaparoscopiccholecystectomycholedochotomyandcholedocoscopiccholelithotomycombinatedwithendoscopicnaso-biliandrainagethenthecommonbileductwasinterruptedlysuturedafterconfirmationofnoresidualstones.Theirclinicdataexpensescomplicationanddurationofhospitalizationtwerecomparewiththoseof42patientsunderwentendoscopicnasobiliaryductplacementbeforetheoperation.ResultsTheclinicaloutcomesinexperimentalgroupsweresignificantlybetterthanthoseofcontrolgroup.Andtheirexpensesandtheratesofcomplicationofpostoperativewerelowerthanthoseofcontrolgroup（PKeywords：Laparoscopiccommonbileductexploration；Endoscopicbiliarydrainage；Biliarytract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（LaparoscopiccholecystectomyandlaparoscopiccommonbilcductexplorationandendoscopicnasobiliarydrainageLC+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（EndoscopicretrogradecholangiopancreatographyandEndoscopicSphincterotomycombinedwithLaparoscopiccholecystectomyERCP+EST+LC）。比较两组患者临床效果现报道如下。1资料与方法1.1一般资料我院2003年3月～2009年3月收治的145例胆囊结石合并胆总管结石患者全部经Bus、CT、MRCP检查确诊。其中103例行LC+LCBDE+ENBD治疗；42例行ERCP+EST+LC治疗。两组患者临床资料见表1。1.2方法L