Management of Gallstones with Choledocholithiasis: Comparison Between One Session and Two Sessions by Laparoscopic Technique Combined with Endoscopic Technique_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

嵇振岭 ¹ , 周家华 ¹ , 张炜 ² , 李平军 ³ , 李国强 ¹ , 杨德同 ¹

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Keywords：

胆囊结石; 肝外胆管结石; 腹腔镜胆囊切除术; 腹腔镜胆管探查取石术; 一期手术; 分期手术

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目的采用腹腔镜、内镜联合技术处理胆囊结石合并肝外胆管结石，对同期及分期治疗的结果进行比较。方法患者60例，其中同期处理36例，分期处理24例。术前诊断依据B超、ERCP或MRCP检查，术中诊断依据术中胆道镜检查和胆道造影，全部病例均诊断为慢性胆囊炎合并胆总管结石。同期手术者直接行腹腔镜胆囊切除术，胆道镜和（或）造影检查后行腹腔镜经胆囊管或胆总管胆道镜取石，闭合胆管开口或放置T管。分期手术者先行或者后行ERCP+经内镜乳头切开术/经内镜乳头气囊扩张术取石，再行常规的腹腔镜胆囊切除术。结果 60例患者腹腔镜胆囊切除术均成功，同期手术者手术时间40～90 min，平均68 min，术后发生1例漏胆；分期手术者2次手术时间共60～120 min，平均80 min。同期手术者手术时间明显短于分期手术者（P＜0.01），而术后并发症发生情况二者间差异则无统计学意义（P gt;0.05）。同期手术者住院费用较少（P＜0.01），同时在胆总管一期缝合或胆囊管一期结扎的情况下，住院时间相对较短（P＜0.01）。结论腹腔镜胆囊切除术＋腹腔镜下胆道镜胆总管探查术或经胆囊管探查术同期治疗胆囊结石合并肝外胆管结石安全可靠，值得进一步研究、推广。

Citation： 嵇振岭,周家华,张炜,李平军,李国强,杨德同. Management of Gallstones with Choledocholithiasis: Comparison Between One Session and Two Sessions by Laparoscopic Technique Combined with Endoscopic Technique. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(5): 400-402. doi: Copy

1.	Sgourakis G, Karaliotas K. Laparoscopic common bile duct exploration and cholecystectomy versus endoscopic stone extraction and laparoscopic cholecystectomy for choledocholithiasis. A prospective randomized study [Ｊ]. Minerva Chir，2002; 57(4): 467-474.
2.	Hong DF, Gao M, Bryner U, et al. Intraoperative endoscopic sphincterotomy for common bile duct stones during laparoscopic cholecystectomy [Ｊ]. World J Gastroenterol, 2000; 6(3): 448-450.
3.	Ji ZL, Peng SY, Cai XJ. A laparoscopic multifunctional operative device in laparoscopic hepatectomy [Ｊ]. Chirurgische Gastroenterologie, 2004; 20（4）: 308-312.
4.	李平军, 杨峻峰, 胡伟, 等. 2 892例腹腔镜胆囊切除术无胆道损伤的临床经验 [Ｊ]. 中华消化内镜杂志, 2005; 22（3）: 203-204.
5.	Duensing RA, Williams RA, Collins JC, et al . Managing choledocholithiasis in the laparoscopic era [Ｊ]. Am J Surg, 1995; 170(6): 619-623.
6.	Paganini AM, Feliciotti F, Guerrieri M, et al. Laparoscopic common bile duct exploration [Ｊ]. J Laparoendosc Adv Surg Tech A, 2001; 11(6): 391-400.
7.	陈安平, 鲁美丽, 高珂, 等. 腹腔镜胆总管探查术693例报告 [Ｊ]. 中华普通外科杂志, 2004; 19（2）: 82-84.
8.	秦明放, 赵宏志, 王庆, 等. 微创治疗肝外胆管结石阶梯性方案研究 [Ｊ]. 中国实用外科杂志, 2004; 24（2）: 88-90.
9.	Wright BE, Freeman ML, Cumming JK, et al. Current management of common bile duct stones: is there a role for laparoscopic cholecystectomy and intraoperative endoscopic retrograde cholangiopancreatography as a single-stage procedure? [Ｊ]. Surgery, 2002; 132(4): 729-735.
10.	Wei Q, Wang JG, Li LB, et al. Management of choledocholithiasis: comparison between laparoscopic common bile duct exploration and intraoperative endoscopic sphincterotomy [Ｊ]. World J Gastroenterol, 2003; 9(12): 2856-2858.
11.	De Palma GD, Angrisani L, Lorenzo M, et al. Laparoscopic cholecystectomy (LC), intraoperative endoscopic sphincterotomy (ES), and common bile duct stones (CBDS) extraction for management of patients with cholecystocholedocholithiasis [Ｊ]. Surg Endosc, 1996; 10(6): 649-652.
12.	Shah SK, Mutignani M, Costamagna G. Therapeutic biliary endoscopy [Ｊ]. Endoscopy, 2002; 34(1): 43-53.
13.	冯作忠. 经胆囊管行术中胆道镜胆道探查68例分析 [Ｊ]. 中国普外基础与临床杂志, 2008; 15(3): 208-209.
14.	胡三元. 肝内、外胆管结石的腹腔镜处理 [Ｊ]. 中国普外基础与临床杂志, 2008; 15(10)： 711-713.
15.	王敬民，孙登群，杨柳生. 腹腔镜下胆囊管结石的正确处理与并发症的预防 [Ｊ]. 中国普外基础与临床杂志, 2006; 13(4): 399-400.
16.	蔡珍福, 王坚. 纤维胆道镜胆总管探查后不放置T管的体会 [Ｊ]. 中华普通外科杂志, 1999; 14(5): 393.
17.	刘扬, 宗明, 龚彪, 等. 腹腔镜胆囊切除结合内镜Oddi’s括约肌切开取石二期治疗胆道结石 [Ｊ]. 肝胆胰外科杂志, 2003; 15(4): 239-240.

1. Sgourakis G, Karaliotas K. Laparoscopic common bile duct exploration and cholecystectomy versus endoscopic stone extraction and laparoscopic cholecystectomy for choledocholithiasis. A prospective randomized study [Ｊ]. Minerva Chir，2002; 57(4): 467-474.
2. Hong DF, Gao M, Bryner U, et al. Intraoperative endoscopic sphincterotomy for common bile duct stones during laparoscopic cholecystectomy [Ｊ]. World J Gastroenterol, 2000; 6(3): 448-450.
3. Ji ZL, Peng SY, Cai XJ. A laparoscopic multifunctional operative device in laparoscopic hepatectomy [Ｊ]. Chirurgische Gastroenterologie, 2004; 20（4）: 308-312.
4. 李平军, 杨峻峰, 胡伟, 等. 2 892例腹腔镜胆囊切除术无胆道损伤的临床经验 [Ｊ]. 中华消化内镜杂志, 2005; 22（3）: 203-204.
5. Duensing RA, Williams RA, Collins JC, et al . Managing choledocholithiasis in the laparoscopic era [Ｊ]. Am J Surg, 1995; 170(6): 619-623.
6. Paganini AM, Feliciotti F, Guerrieri M, et al. Laparoscopic common bile duct exploration [Ｊ]. J Laparoendosc Adv Surg Tech A, 2001; 11(6): 391-400.
7. 陈安平, 鲁美丽, 高珂, 等. 腹腔镜胆总管探查术693例报告 [Ｊ]. 中华普通外科杂志, 2004; 19（2）: 82-84.
8. 秦明放, 赵宏志, 王庆, 等. 微创治疗肝外胆管结石阶梯性方案研究 [Ｊ]. 中国实用外科杂志, 2004; 24（2）: 88-90.
9. Wright BE, Freeman ML, Cumming JK, et al. Current management of common bile duct stones: is there a role for laparoscopic cholecystectomy and intraoperative endoscopic retrograde cholangiopancreatography as a single-stage procedure? [Ｊ]. Surgery, 2002; 132(4): 729-735.
10. Wei Q, Wang JG, Li LB, et al. Management of choledocholithiasis: comparison between laparoscopic common bile duct exploration and intraoperative endoscopic sphincterotomy [Ｊ]. World J Gastroenterol, 2003; 9(12): 2856-2858.
11. De Palma GD, Angrisani L, Lorenzo M, et al. Laparoscopic cholecystectomy (LC), intraoperative endoscopic sphincterotomy (ES), and common bile duct stones (CBDS) extraction for management of patients with cholecystocholedocholithiasis [Ｊ]. Surg Endosc, 1996; 10(6): 649-652.
12. Shah SK, Mutignani M, Costamagna G. Therapeutic biliary endoscopy [Ｊ]. Endoscopy, 2002; 34(1): 43-53.
13. 冯作忠. 经胆囊管行术中胆道镜胆道探查68例分析 [Ｊ]. 中国普外基础与临床杂志, 2008; 15(3): 208-209.
14. 胡三元. 肝内、外胆管结石的腹腔镜处理 [Ｊ]. 中国普外基础与临床杂志, 2008; 15(10)： 711-713.
15. 王敬民，孙登群，杨柳生. 腹腔镜下胆囊管结石的正确处理与并发症的预防 [Ｊ]. 中国普外基础与临床杂志, 2006; 13(4): 399-400.
16. 蔡珍福, 王坚. 纤维胆道镜胆总管探查后不放置T管的体会 [Ｊ]. 中华普通外科杂志, 1999; 14(5): 393.
17. 刘扬, 宗明, 龚彪, 等. 腹腔镜胆囊切除结合内镜Oddi’s括约肌切开取石二期治疗胆道结石 [Ｊ]. 肝胆胰外科杂志, 2003; 15(4): 239-240.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Management of Gallstones with Choledocholithiasis: Comparison Between One Session and Two Sessions by Laparoscopic Technique Combined with Endoscopic Technique

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