双镜联合同期治疗胆囊结石合并胆总管结石的策略

被引：84

作者：

张宗明

苑海明

张翀

机构：

[1] 首都医科大学北京电力医院普通外科

来源：

中华消化外科杂志 | 2015年 / 14卷 / 04期

关键词：

胆石症; 腹腔镜检查; 胆道镜检查; 十二指肠镜检查;

D O I：

暂无

中图分类号：

R657.42 [];

学科分类号：

摘要：

胆囊结石合并胆总管结石是一种常见、多发疾病, 近年来传统的开腹手术受到微创手术挑战。近年通过全面分析和总结胆囊结石合并胆总管结石的微创治疗现状, 发现双镜联合同期治疗的微创手术成为主流:对于胆总管不扩张(直径<0.8 cm)的胆囊结石合并胆总管结石患者, 首选LC联合内镜乳头括约肌切开(EST)或经内镜十二指肠乳头气囊扩张术(EPBD), 条件具备时可选用LC联合胆道镜经胆囊管胆总管结石取石术。对于胆总管扩张(直径>0. 8 cm)的胆囊结石合并胆总管结石患者, 首选LC联合胆道镜胆总管切开取石、T管引流术, 如果胆总管结石已取尽、胆总管下端通畅、Oddi括约肌功能良好, 可行胆总管一期缝合。术者合理选择双镜联合的微创手术方案, 对于提高胆囊结石合并胆总管结石的治疗效果、避免术后并发症或隐患具有重要的临床意义。

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