Andreev A L, Rybin E P, Uchvatkin V G, Sedletskiĭ V V, Filin A S, Priadko A S, Grakh S I
Vestn Khir Im I I Grek. 1997;156(3):30-4.
The article deals with combined endoscopic treatment of cholelithiasis complicated by pathological changes of the terminal part of the common bile duct in 104 patients: in 81 of them there was choledocholithiasis (5 of them had the Mirizzi syndrome). 15 patients had choledocholithiasis and papillostenosis, 8 patients had papillostenosis. Papillosphincterotomy with laparoscopic cholecystectomy was performed in 50 patients, in 4 senile patients only papillosphincterotomy was performed. Laparoscopic cholecystectomy and interventions on the common bile duct were fulfilled in 46 patients; in 27 cases the duct was drained by the method of Holsted-Pikovskiĭ, in 13 cases--after Kehr, in 3--after Vishnevskiĭ. In 2 cases the concrements were removed through the cystic duct, the common bile duct was not drained. The supraduodenal choledochoduodenoanastomosis was made in one patient. The open operation was performed in 4 cases (3.9%). One patient died (1%). The experience shows that the modern endoscopic technique allows the whole program of intraoperative revision and sanitation of the hepaticocholedochus and its drainage to be realized. Advantages of the combined endoscopic treatment of the cholelithic disease complicated by a lesion of the terminal part of the common bile duct as compared with traditional surgery are evident. They are: decreased postoperative pain syndrome, less amount of complications, good cosmetic affect, shorter period of reconvalescence, high economic effect.
本文探讨了104例合并胆总管末端病理改变的胆石症患者的内镜联合治疗：其中81例为胆总管结石（5例合并Mirizzi综合征）。15例患者合并胆总管结石和乳头狭窄，8例患者仅有乳头狭窄。50例患者行乳头括约肌切开术联合腹腔镜胆囊切除术，4例老年患者仅行乳头括约肌切开术。46例患者行腹腔镜胆囊切除术及胆总管干预；27例采用Holsted-Pikovskiĭ法引流胆总管，13例采用Kehr法，3例采用Vishnevskiĭ法。2例通过胆囊管取出结石，未引流胆总管。1例患者行十二指肠上胆总管十二指肠吻合术。4例（3.9%）行开放手术。1例患者死亡（1%）。经验表明，现代内镜技术能够实现肝外胆管术中全面检查和清理及其引流的整个程序。与传统手术相比，合并胆总管末端病变的胆石症内镜联合治疗的优势明显。这些优势包括：术后疼痛综合征减轻、并发症减少、美容效果好、康复期缩短、经济效益高。
