纤维胆道镜在小切口胆道取石术中的应用

Application of fibercholangioscope in choledocholithotomy with minimal incision

目的探讨纤维胆道镜在小切口胆道手术中的治疗效果。方法应用纤维胆道镜术中经胆总管切口入路、经胆囊管口入路,胆总管切开取石+T管引流者570例,胆总管探查术后一期缝合胆总管、不置T管者695 例,经胆囊管口途径取石后直接结扎胆囊管者120例,肝叶切除+胆总管切开取石十T管引流者或胆管空肠Roux- Y吻合术者71例。结果术中结石取净率达96％,术后残石率为3．6%,结石复发率为1．4％。胆总管直接缝合病例中5例术后引流管内引出胆汁样液体,最多者每日达100 ml,经持续负压引流5-12 d后自愈,考虑为针眼漏胆。结论应用纤维胆道镜明显提高了小切口胆道手术的成功率,降低了术后残石率和结石复发率。

Objective To explore the earative effect of fibercholangioscope in choledocholithotomy with minimal incision, Methods Choledocholithotomy plus T-tube drainage was performed using fibercholangioscope via a minimal incision on the common bile duct （CBD） or the cystic duct in 570 patients, CBD exploration with primary suture but without indwelling T-tube was performed in 695 cases, direct ligature on the CBD was made in 120 cases after choledocholithotomy via an incision on the cystic duct, and hepatic lobectomy plus choledocholithotomy with T-tube drainage or choledochodejunostomy （Roux erFY anastomosis） was performed in 71 cases. Results The stone-cleaned rate was 96%, the retained stone rate 3.6% and the stone relapse rate 1.4%. Bile-like fluid was found in 5 patients who undergone direct suture on the CBD, the maximal volume was up to 100 ml daily and bilious effusion could be stopped automatically after 5-12 days＇ persistent drainage of negative pressure. It was considered that it was a pin-hole biliary fistula. Conclusion The successful rate of biliary operation with a minimal incision is obviously raised using fiberchollangioscope. The postoperative reained stone rate and the stone relapse rate are decreased.