探讨同期三镜(腹腔镜、胆管镜、十二指肠镜)、扩张导管(逐级扩张导管、球囊导管)、气囊鼻胆管(LCDND)治疗胆囊结石、胆总管结石、及合并十二指肠憩室周围乳头部梗阻的临床应用体会。

回顾性分析2002年6月至2017年3月治疗胆囊结石、胆总管结石、及合并十二指肠憩室周围乳头部梗阻51例患者治疗的临床资料。

腹腔镜下成功切除胆囊和采用胆管镜探查取石术51例。逐级扩张导管扩张乳头并留置气囊鼻胆管68.6% (35/51)，逐级扩张导管扩张乳头和推挤胆总管下段及乳头部结石入肠腔并留置气囊鼻胆管11.8% (6/51)，逐级扩张导管联合球囊导管扩张乳头并留置气囊鼻胆管3.9% (2/51)，逐级扩张导管扩张乳头、十二指肠镜乳头小切开或微切开并留置气囊鼻胆管13.7% (7/51)，因胆总管残石并腹腔镜下留置T形管2.0% (1/51)。鼻胆管引流术后无残石，胆汁漏1例(2.0%)，轻症胰腺炎2例(3.9%)。无肠穿孔、胆管穿孔、大出血、重症胰腺炎等并发症，无围手术期再次手术和死亡患者。术后总并发症发生率为5.9%(3/51)。

从对本医院有限病例进行初步研究发现，只要病例选择合适，LCDND治疗胆囊结石、胆总管结石、及合并十二指肠憩室周围乳头部梗阻是可行、有效和安全的。

To explore the surgical techniques and clinical effect of combined application of laparoscopy, choledochoscopy, duodenoscopy, dilatable catheter and balloon nasobiliary drainage (LCDND) in treating bile duct stones and papillary obstruction around duodenal diverticulum.

Clinical data of 51 patients with cholecystolithiasis, choledocholithiasis and duodenal diverticulum papilla obstruction were retrospectively analyzed from June 2002 to March 2017.

Fifty-one cases have been successfully removed the gallbladder by laparoscopy and gallstones through the duct incision with choledochoscopy. Step by step dilatable catheter expanded duodenal papilla and indwelling balloon nasobiliary was used in 68.6% (35/51); push the stones into the lumen was applied in 11.8% (6/51); step by step dilatable catheter in combination with balloon catheter expanded duodenal papilla and indwelling balloon nasobiliary were used in 3.9% (2/51); step by step dilatable catheter expanded duodenal papilla, duodenoscopic papillary sphincterotomy with micro incision or small incision and indwelling balloon nasobiliary has been done in 13.7% (7/51); Choledochoscopic examination and indwelling T shape tube drainage due to residual stone in the CBD was used in 2.0% (1/51). No residual stones were found after the nasobiliary drainage. Bile leakage has been cured in one case (2.0%). Two patients (3.9%) had a slight pancreatitis. No case of intestine and bile duct perforation, bleeding, severe pancreatitis or death occurred. The total postoperative complication rate was 5.9% (3/51).

Based on the preliminary research result of limited cases in our hospital. LCDND for treatment of the cholecystolithiasis, choledocholithm, papillary obstruction around duodenal diverticulum is safe and effective for selective patients.