腹腔镜联合胆道镜治疗胆管结石160例

Laparoscopy combined with choledochoscopy for the treatment of bile duct calculi:160 cases analysis

目的:探讨腹腔镜联合胆道镜在胆总管切开取石中的应用方法及疗效.方法:回顾性分析1998-01/2006-12我院160例胆总管结石行胆总管探查、胆道镜取石的临床资料.结果:159例在腹腔镜下顺利完成手术,1例中转开腹.胆总管一期缝合68例,置T管92例,术中取尽结石156例,术后胆道镜取石4例.手术时间70-120(平均115)min,术后住院时间4-11(平均6)d.无胆道出血及腹腔感染,无手术死亡.术后胆漏2例.经再次腹腔镜下缝合与引流治愈.120例随访6-36(平均18)mo,无结石复发和远期并发症.结论:腹腔镜联合胆道镜胆总管探查取石术具有创伤小、恢复快、住院时间短的优点,治疗胆总管结石安全有效.

AIM： To discuss techniques and effects of laparosocopy combined with choledochosopy in choledocholithotomy. METHODS： A retrospective analysis was performed of clinical data on 160 patients with choledochlithiasis that were treated with laparoscopic common bile duct exploration and stone removal with choledochosopy from January 1998 to December 2006 at our hospital. RESULTS： The laparosocopic operation was successfully completed in 159 patients, and a conversion to open surgery was needed in only 1 patient. The primary suture of the bile duct was performed in 68 patients, while T-tube drainage was conducted in 92 patients. The stones were completely removed during the operation in 156 patients; stone removal under choledochosopy was required in 4 patients after the operation. The operation duration was 70-120 minutes （mean, 115 minute）. The postoperative hospital stay was 4-11 days （mean, 6 days）. No bile duct hemorrhage or abdominal infection was seen. No fatalities were noted. Postoperative biliary leakage occurred in 2 patients, and both were cured with a second suture and drainage with laparoscopy. Follow-up observations in 120 patients for 6-36 months （mean, 18 months） found no recurrence of bile duct stones or long-term complications. CONCLUSION： Laparoscopy combined with choledochoscopy for choledocholithotomy has the advantage of less invasion, rapid recovery and shorter hospitalization. It is a safe and effective method for bile duct stones.