腹腔镜胆总管再次手术的临床应用体会(附10例报告)

Clinical experience of second laparoscopic choledochotomy(a report of 10 cases)

目的探讨腹腔镜胆总管再次手术应用特点。方法回顾性总结和分析10例腹腔镜胆总管再次手术的临床资料,其中4例结石位于胆总管上段,6例位于胆总管下段,结石数目1～5个,5例合并黄疸及肝功能损害。10例行腹腔镜胆总管切开取石(LCTD)者胆总管直径均大于10mm,其中3例胆总管直径>12mm,行一期缝合;7例因取石时间长,乳头水肿或肝功能有损害,予以放置T管。结果10例平均手术时间为152min。一期缝合者术后7d出院,留置T管者术后经T管胆道造影,未见胆总管残余结石,术后1个月拔除T管。结论术中粘连的分离及胆道镜取石是手术的重点,腹腔镜胆总管再次手术是可行的,相对传统开腹手术创伤小,恢复快,住院时间短,值得推广。

Objective To investigate the operation method and effect of recurring common bile duct stone with laparoscopy. Methods Ten cases were analyzed retrospectively. 4 cases had stones on the superior segment of common bile duct, and 6 cases had stones on the inferior segment. Stone number ranged from one to five. 5 cases combined with jaundice and liver function harm. All the common bile duct diameter were over 10 mm and they all received laparoscopic choledochotomy. 3 cases with primary closure and 7 cases put T tube for drainage. Results 3 of 10 cases accepted primary closure, and 7 cases with routine T- tube drainage. The mean operating time was 152 min. The mean postoperative hospitalization time of patients accepted primary closure was 7 days ; the patients with routine T - tube drainage accepted cholangiography 7 days after operation, and without remnant stone. The mean postoperative hospitalization time was 9 days. One month after operation T - tube was pull out. Conclusion In the technique the adhesion separation and using biliary duct mirror to take the stone is the surgery key point. It is concluded that the whole procedures of above mentioned operation were save with lesser operative trauma and more rapid recovery with minimal uneasiness of the patients. So these advanced operative procedures can be extended and popularized.