腹腔镜联合内镜手术治疗胆总管结石132例临床分析

Clinical analysis of laparoscopic operation combined with endoscopes in treatment of 132 cases with choledocholithiasis

目的探讨腹腔镜联合内镜治疗胆总管结石的方法、适应证及临床价值。方法应用腹腔镜胆总管切开取石+胆道镜探查取石术(LCDE)治疗胆总管结石,联合内镜(十二指肠镜)处理胆总管结石和术后残石等并发症。结果鼻胆管引流49例,LCDE110,术后残石23例,6例未取净,内镜取净17例,胆漏5例,腹腔引流管持续少量胆漏经保守治疗4例治愈,化脓性胆管炎1例,中转开腹9例,无1例死亡。手术时间与开腹手术接近,术后住院时间明显缩短。部分病例随访6～12月以上未见远期并发症。结论腹腔镜联合内镜治疗胆总管结石,具有创伤小、有效、安全等优点;此术式可代替大部分开腹胆总管探查术,值得临床推广。

Objective: To explore methods,indications and clinical value of laparoscopic operation combined with endoscopics in treatment of choledocholithiasis. Methods: Laparoscopic choledocholithotomy, choledochoscopic cholelithotomy and papillosphincterotomy (with duodenoscope) were performed to treat common bile duct stones and complications such as residual stones. Results: There were 132 patients in the group, 49 cases were placed with nasal bile tube drainage before laparoscopic choledocholithotomy, and LCDE were performed among 110 cases. There were 23 patients existed residual stones in these 110 patients, with 17 cases cleared up by choledochoscope and 6 cases still existed residual stones. Bile leakage occurred among 6 patients with a small quantity of bile in the drainage-tube of abdominal cavity. And 4 cases were cured by conservative therapy. Suppurative cholangitis occurred in 1 case. laparoscopic choledocholithotomy of 9 cases were transferred into open-abdominal operation.There was no died case. The consumed -time of laparoscopic choledocholithotomy was near to that of opening operation. Postoperative length of stay significantly shortened. No long-term complications has been found among partial patients who accepted follow-up over from 6 months to 12 months. Conclusion: Laparoscope, which is combined with endoscope, is applied to treat choledocholithiasis with several advantages including tiny wound, effectiveness and safty. This operative technique may replace majority of opening choledocholithotomy and deserve clinical popularization.