腹腔镜联合胆道镜治疗重症急性胆管炎(附41例报告)

Laparoscopic Treatment Adjuvant with Choledochoscopy for Acute Cholangitis of Severe Type:Report of 41 Cases

目的:探讨腹腔镜联合胆道镜在重症急性胆管炎(ACST)治疗中的应用价值。方法:腹腔镜胆总管切开、胆道镜探查取石、T管引流术(LCDE)。结果:腹腔镜胆囊切除术(LC)及LCDE37例,LCDE4例,无中转开腹。术中取尽结石33例,术后再次胆道镜取尽残石4例,因胆总管下段狭窄等原因择期开腹手术4例。术后发生胆漏4例,应激性溃疡出血1例,死亡2例。结论:腹腔镜联合胆道镜手术治疗ACST有效、可行。

Objective： To assess the value of laparoscopic treatment adjuvant with choledochoscopy for acute cholangitis of severe type. Methods： Cholecystostomy （LC）, laparoscopic CBD exploration （LCDE） and T tube drainage. Results： Thirtyseven patients were successhdly treated by LC and LCDE, and 4 pantients by LCDE, and no one was taeated by laparotomy. The biliary stones were completely cleared during emergency operation in 33 patients, 4 patients had residual stones which were removed by second choledochuscopic exploration, and 4 patients had open abdominal operation for other reasons later. After operation, 4 patients had leakage of bile, 1 patient suffered stress ulcer and bleeding and 2 patients died. Conclusion： Laparoscopy adjuvant with choledochoscopy was technically feasible and effective for patients with acute cholangitis of severe type.