小切口胆囊切除术中经胆囊管胆道镜取石的应用价值

THE VALUE OF CHOLEDOCHOFIBEROSCOPY FOR CALCULI EXTRACTION THROUGH CYSTIC DUCT DURING MINICHOLECYSTECTOMY

目的认识经胆囊管胆道镜下网篮取石在小切口胆囊切除术中的应用价值。方法在2001年6月至2004年11月间,在胆囊结石合并继发性胆总管结石的病例中,行小切口胆囊切除术并经胆囊管胆道镜下网篮取石46例。结果成功44例,失败2例,其中1例因胆囊管较细胆道镜不能通过,另1例因结石位于肝总管内网篮取出困难,此2例均行胆总管切开胆道镜下网篮取石,胆总管一期缝合;取出结石最多8枚;结石最大直径为9mm;术后平均住院日为6.5天。结论经胆囊管胆道镜下网篮取石术是一种低创胆道手术方法,对病人创伤小,并缩短住院日。在小切口胆囊切除术中应用此技术,更加突出了低创效果,具有重要的临床价值。

Objective To recognize the value ot choledochofiberoscope for removing bile duct stones witn grasping basket through cystic duct during minicholecystectomy. Methods 46 cases of cholecystolithiasis combined with secondary common bile duct stones were treated by minicholecystectomy and by removing bile duct stones with grasping basket through cystic duct under choledochofiberoscope from June, 2001 to November, 2004. Result 44 cases were operated successfully,while the other 2 cases,in which the choledoch fibroscope couldn＇t enter through the cystic duct and the stone was at common hepatic bile duct respectively,were carried out by removing bile duct stones through CBD incision with grasping basket under choledoch fiberoscope. The largest number of removed bile duct stones was 8. The diameter of largest stone was 9 millimeter.The mean hospital stay after operation was 6. 5 days. Conclusion Removing bile duct stones with grasping basket through cystic duct under choledochofiberoscope is a good method which is less invasive and can shorten the hospitalization time. When used in minicholecystectomy,this technique makes less injury to patients. Thus it is worth using in clinical practice.