改进的腹腔镜胆总管探查方法可行性探讨

The study of the feasibility of improved laparoscopic bile duct exploration

目的:探讨改进的腹腔镜胆总管探查方法的可行性。方法:改剑突下孔(B孔)横行切口为纵行。不必将纤维胆道镜列为必备器械。常规胆道取石钳及取石网蓝可直接进入胆道取石,必要时探子经B孔进入胆道下段扩张Odd i括约肌,其余方法与常规相同。结果:31例中1例疑探子“穿破”胆道下段而中转开腹,经查无误后T管引流。2例术后出现胆漏,经引流5d治愈。平均住院7d。4周后造影拔管。30例均无残石。结论:改进的胆总管探查方法不需特殊器械,操作简便、易行、安全。

Objective-To discuss the feasibility of improved laparoscopic bile duct exploration. Methods：The procedures were performed without choledochofiberscopy, by changing horizontal incision into microtubule incision of subxiphoid process port（ B port）, using choledochoscopic net-basket and routine laparotomic instruments to remove stone. Results： In the 31 cases, 1 case required conver- sion to open operation and laying up T-tube due to suspiction of lower level bile duct injury. Among other 30 cases ,2 cases of biliary fistula recovered by abdominal drainage tube for 5 days, and all 30 cases removed T-tube after biliarygTaphy without residual choleiith. Conclusions：Improved laparoscopic bile duct exploration without choledochofiberscopy is easy and safe.