腹腔镜胆总管探查术中胆管镜下乳头切开术的应用

Clinical Application of Choledocoscopic Papillotomy during The Course of Laparoscopic Common Bile Duct Exploration

目的探讨腹腔镜胆总管探查术中胆管镜下乳头切开术的手术方法和适应证。方法斑马导丝引导下的胆管逐级扩张导管或球囊导管对乳头狭窄扩张后,针式刀经胆管镜钳道在胆管逐级扩张导管指引下对乳头狭窄行切开术。结果86例中65例乳头狭窄切开成功,不成功的21例中转为其他术式。无肠穿孔、胆管穿孔、大出血、重症胰腺炎等严重并发症,无死亡。结论在有条件的单位,只要选择合适的病例,腹腔镜胆总管探查术中胆管镜下乳头切开术是可行、有效和安全的。

Objective：To explore the operation methods and indications of choledocoscopic papiUotomy during the course of laparoscopic common bile duct exploration. Methods： To track along the zebra guidewire, the dilatable catheter and balloon were used to dilate the stenosis of papillary.Then were used to cut through the stenosis of papillary for electro-knife by pin-head-like to track along the dilatable catheter with the zebra guidewire. Results： Choledocoscopic papillotomy during the course of laparoscopic common bile duct exploration was successful in 65 out of 86 cases.Twenty-one cases were shifted to other operation. There were no perforation of intestine and bile duet, bleeding, severe pancreatitis and death. Conclusion： If patients are suitable, choledocoscopic papillotomy during the course of laparoscopic common bile duct exploration is safe and effective in the hands of skilled endoscopiests.