另外，利用十二指肠镜还可以行逆行胆囊插管，向胆囊内注入ETBE等溶剂，可将 胆石溶解，适用于胆囊胆固醇结石，且不宜手术者。该方法创伤小、副作用少、溶石效率高。
4.3 腹腔镜 腹腔镜在胆石症的治疗方面，主要用来行胆囊切除术，还可施行胆总管切开取石。经腹腔镜行胆总管切开取石术治疗胆总管结石可减少手术并发症［12］。优点是患者住院时间短、腹部切口损伤小、并发症少、节省手术费用等。
5 手术治疗
5.1 开放性胆囊切除术 主要应用于慢性胆囊炎伴症状的胆囊结石、伴有糖尿病的无症状胆囊结石以及急性胆囊炎甚至胆囊炎并胆总管结石。胆囊癌、梗阻性黄疸、凝血障碍、出血倾向及全身情况差者为禁忌。其发并症为：①出血：来自胆囊动脉及其分支；②误伤胆总管、肝总管及左右肝管；③胆汁漏及胆汁性腹膜炎；④腹壁血肿、感染；⑤肠梗阻、腹膜炎；⑥胆管残余结石、气胸、肠壁损伤等。术前若发现有胆管结石，可作以下几种选择：①开放性胆囊切除术+胆总管切开术；②腹腔镜胆囊切除术后内窥镜括约肌切开取石；③胆囊管腹腔镜取石或腹腔镜胆总管切开术+胆囊切除取石。
5.2 胆肠吻合术 不能取出的胆总管下端结石、不能取出的肝管结石且无黄疸或严重的胆汁淤积，信捷职称论文写作发表网，可施行胆总管十二指肠吻合术。部分肝内胆管结石可行肝叶切除术。
参考文献：
1 Toshio ito, Sumio Kawata, Yasuharu imai, et al. Hep-atic cholesterol metabolism in patient with cholesterol gallstones:enhanced intracelluar transport of cholesterol. Gastroenterology, 1996, 110(5):1619
2 Chapman B A, Burt M J, Chisholm R J, et al. Disso-lution of gallstones with simvastin:An HMG-CoA reductase inhibitor. Digestive Diseases and Sciences, 1998,43(2):349
3 Mittienen T E,Kiviluto T,Taavitsainen M,et al. Cho-lesterol metabolism and serum and billary noncholest-erol sterols in gallstone patients during simvastain and ursodeoxycholic acid treatments. Hepatology,1998,27(3):649
4 顾树南, 李清潭编著. 胆道外科学. 兰州: 甘肃科学技术出版社, 1994.646
5 Karel J, Erpecum Van, Portincasa Piero,et al. Ursod-eoxycholic acid reduces protein levels and nucleation-promoting acting in human gallbladder bile . Gatroenterology, 1996,110(4):1225
6 Perira S P, Veysey M J, Kennedy C, et al. Gallstone dissolution with oral bile acid therapy: Importance of pretreatment CT scanning and reason for nonresponse. Digestive Diseases and sciences, 1997,42(8):1775
7 施维锦主编. 胆道外科学. 上海: 上海科学技术出版社, 1993.250
8 Tazuma S, Kajiyama G, Mizuno T, et al. A combin-ation therapy with simvastin and ursodeoxycholic acid is more effective for cholesterol gallstone dissolution than is ursodeoxycholic acid monotherapy. Journal of Clinical Gastroenterology, 1998,26(4):287
9 Zakko S F, Scirica J C, Guttermuth M C, et al. Et-hyl propionate is more effective and less cytotoxic than methyl tert-butyl ether for gallstone dissolution. Gastroenterology, 1997,113(1):232
10 Takacs T, Lonovics J, Caroli-Bosc F X, et al. Cont-act litholysis of common bile duct stones: Experience in 44 patients. Gastroenterologic Clinique & Biologique, 1997,21(10):655
11 Behjou B, Prat F, Fritsch G, et al. Intracorporeal sh- ockwave lithotripsy in complex bile duct lithiasis compariaon of endoscopic techniques and follow up results. Gastroenterologic clinique &&nbs p;Biologique, 1997,21(10):648
12 Shing-Moo Huang, Chen-Wun Wu, Gar-Yang Chau, et al. An alternative approach of choledocholithotomy via laparoscopic choledochotomy. Arch Surgery, 1996,131(4):407
