文档介绍：1 胆囊结石合并胆管结石微创治疗方案的选择【摘要】目的探讨胆囊结石合并继发胆道结石微创治疗的合理方案。方法 108 例胆囊结石合并可疑胆道继发结石均行腹腔镜胆囊切除术( laparoscopic cholecystectomy , LC ), 其中腹腔镜联合胆道镜经胆囊管胆道探查取石( laparoscopic mon bile duct exploration , LTCBDE ) +LC 70 例,腹腔镜联合胆道镜胆总管切开胆道取石( mon bile duct exploration , LCBDE ) +LC 35例, 其中放 T 管 14 例,不放 T管 21 例,内镜乳头肌切开术(endoscopic sphincterotomy , EST) 术后行胆囊切除 3例。结果 LCBDE+L C 术后放 T 管组中有 1 例胆漏经保守治疗治愈, 4 例术后胆道造影发现胆道残余结石经胆道镜取出结石治愈, 其他病例无胆漏, 术后 3 月复查 B 超无残余胆道结石, 所有病例术后无胰腺炎发作。结论在胆囊结石继发胆道结石的治疗中合理选择多种微创手术方法能降低创伤及减少并发症的发生。【关键词】胆囊结石病胆管结石胆囊切除术腹腔镜 2 Selection of project of minimal invasive operations in gallstones with choledocholithiasis Abstract Objective To study the suitable minimal invasive methods to treat the gallstones with secondary choledocholithiasis. Methods The choledocholithiasis , choledochectasia bined with jaundice were found in 108 cases of gallstones. All these patients were divided into four groups according to the results of the examination before operation :① Laparoscopic cholecystectomy (LC) was performed in gallstones only. ② LC+laparoscopic mon bile duct exploration (LTCBDE) were performed in bined choledocholithiasis with cystic dilation. No T tube drainage was used. ③ LC+mon bile duct exploration (LCBDE) was performed in bined choledocholithiasis with no cystic dilation. Common bile duct was sutured in time without T tube drainage in those with a few stones. Otherwise ,T tube drainag