文档介绍：腹腔镜、胆道镜结合开腹取石器械治疗肝外胆管结石广东省江门市人民医院郭永学王金重李嘉兴(529050) [ 摘要] 目的探讨腹腔镜、胆道镜联合十二指肠镜结合开腹取石器械治疗肝外胆管结石的应用价值。方法自 2000 年以来肝外胆管结石病人 228 例,其中 20 例行内镜下十二指肠乳突切开( EST )取石, 89例行 EST 取石+LC ; 91例行剖腹胆囊切除+胆总管切开取石术; 2005 年以来对不适合 EST 取石或 EST 取石失败者行腹腔镜下胆囊切除、胆总管切开硬性及纤维胆道镜结合开腹胆道取石器械取石术 28 例。结果 137 例患者成功进行三镜联合治疗,术后少量胆汁漏 2 例,无出血、伤口感染等并发症,所有病例均痊愈出院, 随访6~12个月无残余结石和反流性胆管炎。行剖腹胆囊切除+胆总管切开取石术91例中有8例残余结石, 伤口感染 3例,肺部感染 2例,残余结石经 T管窦道胆道镜取石。结论三镜联合治疗肝外胆管结石是安全可靠、疗效确切的微创治疗手段, 明显优于开腹手术, 值得推广使用。【关键词】胆管结石;腹腔镜;十二指肠镜;胆道镜; 取石器械 Three-bined with open surgery for treating extrahepatic bile duct stone Guo Yongxue ,Wang Jinzhong ,Liang Nongliang ,Zeng Gelin ,Li Jiaxin. Jiangmen People ’s Hospital,Guangdong,China 529050 [Abstract] Objective To investgate the value of laparoscope and choledochoscope and endoscopic sphincterotomy (EST) c ombin ed with open surgery for treating extrahepatic bile duct stone. Method we analyzed the es of 228 patients who suffered with bile duct stone since 2000, among which 20 patients underwent EST, and 89 patients underwent EST and LC, and 91 patients underwent gallbladder excision and choledocholithotomy ,28 patients who didn ’t fit for EST or failed in EST underwent LC and laparoscope C holedocholithotomy and fibrocholedochoscop ec ombin ed with open surgery since 2005. R esult s 137 operations were pleted under three- endoscope, only 2 patients result ed in little bile leakage ,plication of bleeding