腹腔镜治疗肝外胆管结石71例分析

Analysis of laparoscope common bile duct exploration for calculi of extrahepatic bile duct in 71 cases

目的探讨常规腹腔镜胆总管切开取石加T管引流(LCHTD)治疗肝外胆管结石的方法技巧和可行性。方法回顾性分析本院2002年2月至2007年11月实施的71例肝外胆管结石患者行常规腹腔镜胆总管探查术(LCBDE)的临床资料。结果70例胆石症患者均在腹腔镜下完成手术,1例因冰冻胆囊中转开腹,手术时间为50～120min,中位数70min。术中失血20～60mL,住院时间5～9d,术后残余结石3例(4.3%),均行经窦道胆道镜取石成功。术后28～35d经T管造影后拔除T管,无胆漏发生。所有患者随访6个月至4年,未发现胆道狭窄和结石复发。结论腹腔镜胆总管探查术治疗肝外胆管结石是一种安全、可行、简便、创伤小、痛苦轻、恢复快、并发症少的手术方法。

Objective To explore the techniques and feasibility of routine laparoscope common bile duct exploration and choledo cholithotomy and T tube drainage management for calculi of extrahepatic bile duct. Methods To retrospectively analyze 71 patients with stone in extrahepatic bile duct who underwent routine common bile exploration by laparoscopy and choledochofiberscopy from 2002.2 to 2007.11. Results Seventy cases were successfully undergone routine laparoseope common bile duct exploration and choledocholithotomy and T tube drainage. One case was transformed laparotomy due to freezing gallbladder. The operation time was 50 --120 min. The median time was 70 min and intraoperative blood loss was 20--60mL. Hospital stay was 5--9d. Three cases had relic stones in the bile duct and stones were removed through the sinus tract by choledochoscope. T duct was taken away after cholangiography and 28--35d of operation. And there were no related complications. Seventy patiants were followed up for 6 months to 4 years,and no biliary tract stegnosis was found. Conclusion Routine laparoscope common bile duct exploration and choledocholithotomy and T tube drainage for calculus of extrahepatic bile duct is a safe type of operation with reliability, convenience, small hurt, light lesion and quick recovery.