胆总管结石的内镜治疗体会

Treating common duct stones by laparoscopic choledochoscopy

目的总结腹腔镜联合纤维胆道镜治疗胆囊结石合并肝外胆管结石的体会,评估"两镜"联合治疗胆石症的临床疗效。方法该院2003年2月～2008年3月284例胆道结石患者,156例行腹腔镜胆囊切除,然后用胆道镜探查胆总管并取石;128例行开腹胆囊切除,胆道取石。结果联合应用腹腔镜胆道镜探查胆总管并取石的成功率为95.51%,仅7例因为结石多发且嵌顿在壶腹而中转开腹。联合组平均手术时间(135.8±32.6)min,与开腹组(122.5±39.2)min相比,差异无显著性,但出血量、术后住院天数、并发症发生率与开腹组比较,差异有显著性。联合组有7例并发症,包括4例胆漏、1例胆汁性腹膜炎、2例残余结石。联合组有96例得到随访,开腹组有107例得到随访,随访时间为3～36个月,二组均无结石复发和胆道狭窄发生。结论腹腔镜联合胆道镜治疗单纯胆总管结石是安全、可行、有效和微创的。

[Objective] To summarize the experiences of laparoscopy combined with fiber cholangioscopy for the treatment of cholecystolithiasis and choledocholithiasis, and evaluate the clinical curative effect of the method. [Methods] We analysed prospectively collected data on 284 explorations of the common bile duct between February 2003 and March 2008, 156 patients were performed by laparoscopy combined with fiber cholangioscopy (Joint Group), then choledochoscope was used to explore the bile common duct; 128 cases...