三镜联合胆总管探查术中取石方法探讨

Study on the appropriate approach of extraction of bile duct stones during the operation of combined duodenoscopic,laparoscopic and choledochoscopic common bile duct exploration.

目的探讨三镜联合胆总管探查术中的取石方法及各种方法的适应证。方法自1998年4月至2004年3月,实施三镜联合胆总管探查术316例,术中根据胆管结石的具体情况,分别或联合应用4种取石方法(水冲法取石、器械直接取石、胆道镜网篮取石、胆道镜激光碎石)取出胆管中结石。结果298例手术成功,中转开腹15例,3例因术中明确肝内胆管结石残留,留置T管。1例术后经ENBD管造影发现胆管中残留结石,应用十二指肠镜取石成功。结论联合应用4种取石方法,能有效地提高三镜联合胆总管探查术中结石取净率。

Objective To study the most appropriate approach and related indications of extraction of bile duct stones during the operation of combined duodenoscopic,laparoscopic and choledochoscopic common bile duct exploration.Methods From April 1998 to March 2004,316 cases received the therapeutic procedures.According to the special conditions of bile duct stones,4 approaches of extraction of bile duct stones were performed,i.e.,saline flushing,tools of laparoscopy or laparotomy,choledochoscopic basket manipulation and laser lithotripsy.Results In 316 cases,the operations in 298 cases were successful.Fifteen cases were converted to laparotomy.Three cases were converted to T-tube drainage because of the residual stones of intrahepatic bile duct in operation.One case was found the residual bile duct stones on postoperative cholangiogram through ENBD-tube,which was successfully removed by postoperative endoscopic therapy.Conclusion It is proved that stone clearance can be markedly improved by the operation of combined duodenoscopic,laparoscopic and choledochoscopic common bile duct exploration through the combination of the four methods of stone extraction.