Application of Three-Endoscopy in Treatment for Elderly Patients with Common Bile Duct Stones Associated with Severe Acute Cholangitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 XU Zhifei , ZHENG Huafang , YUE Yanhong , LIU Rui

Department of General Surgery， Traditional Chinese Medicine Hospital of Meishan City， Meishan 620010， Sichuan Province， China;

Corresponding author：

XU Zhifei, Email: 572506621@qq.com

Keywords：

胆总管结石; 急性重症胆管炎; 腹腔镜; 胆道镜; 十二指肠镜

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Objective 　To summarize the therapeutic efficacy of laparoscope， duodenoscope， and choledochoscope
in treatment for elderly patients with common bile duct stones associated with acute severe cholangitis.
Methods 　Eighty-six patients with common bile duct stones associated with severe acute cholangitis from May 2008 to December 2012 in this hospital were chosen. The operation methods and their therapeutic efficacy were analyzed.
Results 　① Thirty-one patients were performed by laparoscopic cholecystectomy （LC） plus common bile duct discission combined with choledo-choscope for removing the stones， which were completely successful. One case of bile duct perforation happened. The total effective rate was 96.77%（30/31）. The hospital stay was （9.05±2.11） d， the hospital costs was （1.47±0.34） ten thousand yuan. ② Forty-three patients were performed by LC combined with duodenoscopic papillotomy， 42 patients were successful，one patients was turned to the other operation， the retained calculus was found in two patients. The total effective rate was 97.67%（42/43）. The hospital stay was （8.64±1.20） d， the hospital costs was （2.36±0.62） ten thousand yuan. ③ Twelve patients were performed by endoscopic nasobiliary drainage and LC plus common bile duct discission combined with choledochoscope for removing the stones， which were completely successful. The total effective rate was 91.67%
（11/12）. The hospital stay was （11.06±2.33） d， the hospital costs was （2.79±0.41） ten thousand yuan. No severe complications such as intestinal perforation， hemorrhea， and severe acute pancreatitis and no death happened.
Conclusions　 Three-endoscopy in treatment for elderly patients with common bile duct stones associated with severe acute cholangitis has a good therapeutic efficacy， a suitable operation is chosen according to the different conditions of the patients， the success rate is high， the complication rate and the mortality rate are low.

Citation： XU Zhifei,ZHENG Huafang,YUE Yanhong,LIU Rui,.. Application of Three-Endoscopy in Treatment for Elderly Patients with Common Bile Duct Stones Associated with Severe Acute Cholangitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(5): 543-546. doi: Copy

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15.	王海家. 腹腔镜胆囊切除术治疗50例急性化脓性胆囊炎、胆囊结石的临床分析[J]. 中国现代医生， 2012， 50(34)：134-135.
16.	于澜，张抒，黄德全，等. 腹腔镜联合术中胆道镜、十二指肠镜治疗胆囊结石并胆总管结石[J]. 中国普外基础与临床杂志， 2010， 17(4)：323-325.

1. 杜鹏，李旭照，黄允宁，等. 三镜联合在高龄急性胆管炎并胆总管结石和胆囊结石治疗中的应用[J]. 宁夏医科大学学报， 2011， 33(11)：1100-1101.
2. 吴在德，吴肇汉. 外科学[M]. 第7版. 北京：人民卫生出版社， 2010：552-553.
3. 张朝永. 中西医结合联合三镜治疗胆石症合并重症急性胆管炎治疗体会[J]. 中国医药， 2011， 6(1)：63-64.
4. 曹伟生. 48例老年人急性胆囊炎的诊治体会[J]. 黑龙江医药， 2009， 22(4)：569-570.
5. 王志兵. 90例老年急性胆结石性胆囊炎外科治疗体会[J]. 中国现代医生， 2010， 48(36)：176-177.
6. 张晓卫，吴武松. 老年胆囊炎、胆石症65例手术时机选择体会[J]. 陕西医学杂志， 2011， 40(9)：1259.
7. 韩大正，李秋波，丁春生，等. 微创治疗胆囊结石并胆总管结石86例[J]. 医学综述， 2007， 13(5)：F0002.
8. 王广义，王英超. 三镜联合治疗胆囊结石合并胆总管结石[J]. 中华普通外科学文献：电子版， 2010， 4(5)：486-487.
9. 马峻. 腹腔镜胆囊切除术与开腹胆囊切除术临床安全性比较研究[J]. 中国现代医生， 2011， 49(15)：31-32.
10. 钟晓锋. 腹腔镜与开腹胆囊切除术治疗单纯结石性胆囊炎的疗效对比分析[J]. 中国现代医生， 2011， 49(12)：11， 14.
11. 陈盛，郑江华，区应亮，等. 两种微创方式治疗胆囊结石合并胆总管结石的临床疗效比较[J]. 中国普外基础与临床杂志， 2012， 19(11)：1213-1217.
12. Drake BB， Arguedas MR， Kilgore ML， et al. Economical and clinical outcomes of alternative treatment strategies in the manag-ement of common bile duct stones in the elderly：wait and see or surgery?[J]. Am J Gastroenterol， 2006， 101(4)：746-752.
13. Cheng CL， Sherman S， Watkins JL， et al. Risk factors for post-ERCP pancreatitis：a prospective multicenter study[J]. Am J Gastroenterol， 2006， 101(1)：139-147.
14. 倪平志，刘隽，汤可立，等. 胆总管探查术后一期缝合的临床经验及适应证探讨[J]. 中国普外基础与临床杂志， 2011， 18(3)：320-323.
15. 王海家. 腹腔镜胆囊切除术治疗50例急性化脓性胆囊炎、胆囊结石的临床分析[J]. 中国现代医生， 2012， 50(34)：134-135.
16. 于澜，张抒，黄德全，等. 腹腔镜联合术中胆道镜、十二指肠镜治疗胆囊结石并胆总管结石[J]. 中国普外基础与临床杂志， 2010， 17(4)：323-325.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of Three-Endoscopy in Treatment for Elderly Patients with Common Bile Duct Stones Associated with Severe Acute Cholangitis

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