腹腔镜治疗EST失败的复发性胆总管结石

Laparoscopic Treatment for Recurrent Choledocholithiasis due to Failed Endoscopic Spincterotomy

目的探讨腹腔镜治疗EST失败的复发性胆总管结石的方法与疗效。方法2000年1月～2007年1月对EST失败的25例复发性胆总管结石再次行腹腔镜手术治疗。结果本组除1例因十二指肠前壁损伤而中转开腹手术外，24例LCBD获得成功，痊愈出院，无结石残留、胆漏、胆管狭窄等手术并发症。术后18例（72．0％）获随访，平均25（6～48）个月，均无胆管狭窄及结石复发。19例借助内镜下鼻胆管引流导管I期缝合胆总管探查切口，5例胆总管内放置T管引流。结论在熟练掌握腹腔镜技术的基础上，应用腹腔镜治疗EST失败的胆道术后胆总管复发结石是安全、可行的，并体现了微创的优势。

Objective To assess the method and effect of laparoscopic treatment for recurrent choledocholithiasis due to failed endoscopic spincterotomy （EST）. Methods From Jan. 2000 to Jan. 2007, 25 patients of recurrent choledocholithiasis failed by EST were underwent laparoscopic common bile duct exploration. Results 24 cases succeed and 1 converted to open operation because of duodenal anterior injury. All cases discharged without complications such as residual calculus, bile leakage or bile duct; stricture. 18 cases were followed up for 6 to 48 months. Conclusion Laparoscopic treatment can be indicated for recurrent choledocholithiasis due to failed EST with safety, feasibility and minimally invasive when laparoscopic operating skilled.