腹腔镜在胆道术后胆总管结石患者中的应用

The application of laparoscopy in choledocholithiasis after biliary tract operation

目的 探讨腹腔镜治疗胆道术后胆总管结石的疗法及疗效。方法 回顾分析4年间37例胆道术后胆总管结石患者实施腹腔镜胆总管探查术的临床资料。结果 35例手术成功,2例中转开腹。30例借助内镜鼻胆管引流导管Ⅰ期缝合胆总管探查切口,7例胆总管内放置T型管引流。术后无胆漏及残石等并发症。手术时间(168±30.2)min,术后住院(11.5±1.3)d。结论腹腔镜手术治疗胆道术后胆总管结石安全、可行,但腹腔镜下分离粘连及解剖、缝合胆总管较困难。为减少并发症。应掌握中转开腹适应证。

Objective To study on the method of applying laparoseopy for the treatment of choledo cholithiasis after biliary tract operation, and to evaluate its therapeutic efficacy. Methods Thirty-seven cases of common bile duct stones after operation from October 1999 to December 2003, received laparoscopic common bile duct exploration (LCBDE) were retrospectively analyzed. Results Satisfactory results were accepted in 35 cases and the rest two cases converted to laparotomy. Thirty cases had got primary healing by the help of employing endoscopic nasobiliary drainage (ENBD) , 7 cases received T-tube drainage. There was neither residual stones left nor serious after-effect including biliary fistula and hemobilia happened. Mean operative time was ( 168 ±30. 2) min. Mean postoperative stay in hospital was (11.5±1.3) d. Recurrences of calculi and bile duct stricture never happened within 6-48 m follow-up study. Conclusion The laparoscopic procedure is technically feasible and safe alternative, however, the technique in lyses of adhesions, dissection and suture of choledochus are quite difficult, therefore it is recommended to be performed in experienced hands expected to minimize the occurrence of complications, and firmly mastered the indications of conversion to laparotomy as far as possible.