腹腔镜X线联合经胆囊管胆总管网篮取石的探讨

The exploration of removing common bile duct calculi through cystic duct with reticular basket under laparoscope combined with X-ray

目的:探讨腹腔镜胆囊切除术时在X线透视下经胆囊管胆总管网篮取石的可行性。方法:2002年6月至2006年10月85例患者术前均经B超诊断为胆囊结石,伴胆总管扩张、胆总管结石。术中于腹腔镜下经胆囊管、胆总管造影,胆道镜取石网篮,在C臂机透视下用胆道镜网篮取石后经胆囊管取出。结果:85例患者经胆总管造影发现胆总管结石26例,经胆囊管胆总管网篮取石成功21例。3例因胆总管损伤中转开腹。2例腹腔镜下胆总管切开取石T管引流。结论:胆囊结石伴胆总管结石在X线透视下,正确掌握手术操作技巧,经胆囊管胆总管网篮取石可一次完成,术后效果满意。

Objective：To evaluate the feasibility of removing common bile duct calculi through cystic duct with basket under laparoscope combined with X-ray.Methods：Eighty-five patients with cholecystolithiasis diagnosed by B-ultrasound examination from June 2002 to October 2006 were suspected to be with common bile duct calculi because of high level of TBIL or serum amylase.Intraoperative choledochography via cystic duct showed the abnormality of common bile duct,the basket was inserted and the common bile duct calculi were removed via cystic duct under observation of X-ray.Results：Twenty-six cases were found to have common bile duct calculi during operations,and twenty-one cases underwent cholelithotomy via cystic duct with basket.Three cases were converted to the open procedures due to bile duct injury.Two cases underwent laparoscopic common bile duct exploration and T tube drainage.Conclusions：Common duct calculi removed through cystic duct with reticular basket under observation of laparoscope combined with X-ray is feasible and safe with skilled technique.