腹腔镜与胆道镜联合应用治疗胆总管结石初步体会

Laparoscopic Common Bile Duct Exploration and Intraoperative Using Fiber Choledochoscope to Remove Choledocholith

目的：探讨与研究腹腔镜胆总管切开纤维胆道镜取石术治疗胆囊结石合并胆总管结石的手术疗效，总结手术经验。方法：回顾性分析2002年8月至2004年4月共实施腹腔镜胆总管切开纤维胆道镜取石术24例，均疗效满意。结果：手术时间80-240min，平均120min，一期缝合4例，留置T管20例。术后5-10d拔除腹腔引流管，住院时间6-11d。留置T管者，6周后来院行T管造影，证实无胆漏、胆总管狭窄及残留结石后予以拔除T管。1例术后出现胆漏，早期每日引流胆汁300ml，腹腔引流6d愈合，2例发生剑突下操作孔感染，经换药愈合。结论：腹腔镜胆道探查术可以达到开腹手术同样满意的疗效，术后病人痛苦小，病人恢复快，住院时间短，但术后因窦道形成缓慢，T管拔除时间长于开腹手术。病人不很方便。

Objective： The study was attempted to make an evaluation to laparoscopic common bile duct Exploration and Intraoperative by using fiber choledochoscope to remove choledocholith. Method： From 2002 to 2004, 24 patient with cholelithiasis combined with choledocholith who underwent laparoscopic common bile duct exploration and Intraoperative by using fiber choledochoscope to remove choledocholith were retrospectively analyzed. Result： The period of operation ranged form 80min to 240min, the mean operation time is 120min. 4 patients received CBD simultaneous suture, and in 10 cases a T tube was placed in CBD, and the T tube was took out of after 6 months if the cholangiography confirmed no bile fistula, no choledochus constriction and no remain stone. 1 patient occurred bile fistula who treated with abdominal drainage, and after 6 days the patient got fully recover. The incisions inferior to xiphod got infection in 2 patients whose incisions healing after dressing change. Conclusion： Laparoseopic common bile duct exploration and Intraoperative by using fiber choledochoscope to remove choledocholith can get the same satisfying curative effect compare to common abdominal operation. The patient got slight distress and recovered quickly, and the mean postoperative hospital stay is shorter. But the time of T tude detained is longer than common abdominal operation, which may bring some unconvenience to patients.