腹腔镜胆总管探查术中细纤维胆道镜的应用

Application of small flexible choledochoscopy in laparoscopic common duct exploration

4例胆囊结石的病人在行腹腔镜胆囊切除术中行胆道造影并经细纤维胆道镜经胆囊管扩取石。2例经造影证实为胆总管下端结石,1例取石成功,另1例因结石较大而致使取石失败,后经内镜乳头括约肌切开取石成功。1例造影怀疑胆总管下端结石,术中镜检正常。1例切开胆囊管冲洗泥沙样结石并取石成功。LC术中采用细纤维胆道镜检查并取石是一安全有效的手段。

Four patients underwent both laparoxcopic cholecysteAonies and small flexible choledochoscopy and stone extraction. The mean age was 46. 5 years (range 38 to 58),and three of the patients were women. An intraoperative cholangiography (IOC) was performed routinely. 2 patient' IOC revealed stones defects in the distal common bile duct(CBD). 1 patient with two 0. 5cm small stones and debris were removed. Another one with. 0. 8cm stone could not beremoved, because dilation of small cystic duct was limited. Postoperative who was suspected stones in the distal CBD underwent choledochoscopy, the result was normal. One patient wiht observing stones franmented while opening of cystic dcut, IOC was mor-mal, but choledochoscopy found multiple small fragmented stones. Operative time was 3. 5 to 6 hours, operative stay was 2 to 7 days. There was no operative - relative morbidity or mortality. In our initial experience, small flexble choledochoscope can be used for direct visualization of hte ducts, so it is one of the safe and effective methods of managing those patients wiht choledocholithiasis at the time of LC.