硬直胆道镜在腹腔镜胆总管探查术中的应用技巧

The applied value and skill of rigid and straight choledochoscope in laparoscopic common bile duct exploration

目的 探讨硬直胆道镜在腹腔镜胆总管探查术中治疗肝内外胆管结石的应用价值和技巧。方法 回顾性分析2010年2月至2012年2月收治的128例行腹腔镜联合硬直胆道镜胆总管探查治疗肝内外胆管结石患者的临床资料。结果 128例手术均成功。2例中转开腹,仍用硬直胆道镜完成取石,126例完全在腹腔镜硬直胆道镜下完成。22例胆总管Ⅰ期缝合,其他术后均留置"T"管引流。术中胆总管切口撕裂延长11例,均及时给予缝合,术后无出血、胆漏等并发症发生。结石取净率为90.62%(116/128)。术后最长随访2年,术后复发2例。结论 熟悉并规范操作,应用硬直胆道镜治疗肝内外胆管结石手术安全有效,不仅可以取尽胆总管结石,而且可以探查Ⅱ、Ⅲ级肝内胆管并取石。部分胆道膜状狭窄可以用硬镜直接扩张,解除狭窄。

Objective To analyze and discuss the applied skill of rigid and straightcholedochoscope used in laparoscopic common bile duct exploration ( LCBDE) treatment of hepatolithiasisor choledocholithiasis.Methods Treatment course of 128 patients with hepatolithiasis orcholedocholithiasis treated with rigid and straight choledochoscope and LCBDE from February 2010 toFebruary 2012 were retrospectively analyzed.Results In this cohort of patients, laparoscopic surgery wasconverted to open surgery in 2 patients.Choledochotomy was managed by effecting primary closure in 22patients,and the rest, traditionally,is closed with T-tube drainage.The bile duct wall of 11 patients weretorn and prolonged carelessly,but none of them appeared hemorrhage and biliary fistula after sewing up.About 90.62 % patient’s stones were totally removed.Two patients were checked the residual hepatolithiasisduring 2 years following up.Conclusions Under practised and standardized operation,LCBDE with rigidand straight choledochoscope treat for hepatolithiasis or choledocholithiasis is safe and effective.It not onlycan removed the common bile duct stone entirely,but also could explore the Ⅱ-Ⅲ degree hepato-billiaryand take off stones,and parts of the biliary membrane-like strictures can be dilatation with choledochoscopeimmediately.