腹腔镜胆总管探查手术适应证探讨

Discussion in indication of laparoscopic common bile duct exploration

目的探讨腹腔镜胆总管探查术(LCBDE)的手术适应证及其临床疗效。方法总结分析吉林大学第一医院普外科2005年11月至2008年3月成功开展腹腔镜胆囊切除联合纤维胆道镜胆总管探查术83例病人的临床资料。结果成功完成LCBDE81例,其中二次胆道手术3例,手术成功率97.6%;中转开腹2例,中转率2.4%。平均手术时间90min,平均肠蠕动恢复时间2.6d,平均术后住院8d。胆总管一期缝合1例术后胆汁瘘,术后1周自愈;术后胆道残余结石2例,经T管窦道行胆道镜治愈。无腹腔出血、胃肠道损伤等并发症,全部治愈,带T管出院。术后4周回院常规T管造影拔管。结论胆囊结石及胆囊炎合并胆管结石是腹腔镜胆管探查取石术的最佳手术适应证。

Objective To investigate and summarize the indication and clinical therapeutic effect analysis of laparoscopic common bile duct exploration . Methods Summarized and analyzed the clinical data in 83 cases of laparoscopic common bile duct exploration can＇ied out successfully dining November 2005 to March 2008 . Results 81 cases of laparoscopic common bile duct exploration were clone successfully, three of them were secondary operation on biliary tract . 2 cases of conversion to laparotomy had to be adopted. Conversion to laparotomy were required in 2 cases, 81cases were done successfully ,the average operation time was 90 minutes ,the average recovery time of enterokinesia was 2.6 days, the average time of hospitalization ariel＂ operation was 8 days. Primary bile duct suture was performed in 1 cases, in which bile leakage occurred after operation, and self-cured after 1 week. 2 cases of retained calculus in biliary tract ＇after operation were cured by choledochoseope through T tract. There were no complications such as abdominal cavity bleeding, injury of gastrointestinal tract .All the patients were cured and discharged with T-tube . T-tube opacification and extuhation should be done in the forth week after operation. Conclusion cholecystolithiasis and cholecystitis with calculus of bile duct is the best indication of the laparoscopic cholecystectomy -bile duct exploration.