Application of laparoscopic cholecystectomy combined with trans cholecystic duct Choledochal balloon lithotomy
腹腔镜下胆囊切除联合经胆囊管胆总管球囊取石术的应用

摘要

目的 探讨腹腔镜下胆囊切除术（LC）联合经胆囊管胆总管球囊取石术（Trans cholecystic duct Choledochal balloon lithotomy TCDCBL）治疗胆囊结石合并胆总管结石的临床应用及治疗效果。方法 总结2020年10月-2023年2月99例胆囊结石合并胆总管结石在DSA杂交手术间通过腹腔镜下胆囊切除术联合经胆囊管胆总管球囊取石术的临床应用情况及治疗效果。结果 99例患者经LC联合TCDCBL治疗成功， 2例失败患者均改行LC联合经皮经肝十二指肠乳头肌球囊扩张取石术（PTPBD）成功。发生胆囊窝脓肿一例，经B超穿刺置管引流治愈。97例患者术后均无结石残留、胆道感染、胆道出血及继发性胰腺炎发生，介入室放射人员剂量卡无一超标，截稿前随访无结石复发。结论 LC联合TCDCBL治疗胆囊结石合并胆道结石不受胆囊管开口角度限制及管径限制，顺胆道走形取石不受胃肠改道及十二指肠乳头处畸形限制，不损伤 Oddi 括约肌功能及胆管壁，术后恢复等同于LC，射线接触时间与内镜下乳头括约肌切开术（EST）接近，创伤小，适应症广，并发症少且发生率低，是临床一步法微创治疗胆囊结石合并胆道结石实用有效的治疗手段。

Abstract

Objective To investigate the clinical application and therapeutic effect of laparoscopic cholecystectomy combined with trans cholecystic duct Choledochal balloon lithotomy in the treatment of cholecystolithiasis complicated with choledocholithiasis.
Methods To summarize the therapeutic effect and application analysis of 99 cases of cholecystolithiasis combined with choledocholithiasis in DSA hybrid operation room through laparoscopic cholecystectomy combined with transcystic choledochal balloon lithotomy from October 2020 to February 2023.
Results 99 patients were successfully treated with laparoscopic cholecystectomy combined with trans cholecystic duct Choledochal balloon lithotomy, and 2 failed patients were successfully converted to laparoscopic cholecystectomy combined with percutaneous transhepatic papillary balloon dilatation. One case of gallbladder fossa abscess was cured by B-ultrasound puncture and drainage. 97 patients had no residual stones, biliary tract infection, biliary bleeding and secondary pancreatitis after operation. None of the dose cards of radiation workers in the intervention room exceeded the standard. There was no stone recurrence during follow-up before the deadline.
Conclusion   Laparoscopic cholecystectomy combined with trans cholecystic duct Choledochal balloon lithotomy in the treatment of cholecystolithiasis complicated with biliary calculi is not limited by the opening angle and diameter of the cystic duct, the shape of the biliary tract is not limited by gastrointestinal diversion and duodenal papilla deformity, and does not damage the function of Oddi sphincter and bile duct wall. The postoperative recovery is equivalent to Laparoscopic cholecystectomy. The ray contact time is close to that of endoscopic sphincterotomy, with less trauma, wide indications, less complications and low incidence, It is a practical and effective combined minimally invasive treatment for cholecystolithiasis complicated with biliary calculi.