腹腔镜下胆总管探查取石术21例分析

Analysis of 21 Cases Operated by Choledoch Exploration and Choledocholithotomy with Laparoscope

目的探讨腹腔镜下胆总管探查取石术(LCBDE)的优点、方法、适应证及术后胆总管引流的必要条件。方法运用腹腔镜下胆总管切开,专用胆石钳取石和/或在胆道镜直视下取石,回顾性分析胆总管结石患者行腹腔镜胆总管切开取石术的术式及特点。结果21例患者均在腹腔镜下成功完成胆总管切开取石术,无中转开腹,平均手术时间145min,平均出血75mL,平均住院6d。3例患者术后出现轻微胆漏,保守治疗4d后痊愈;5例发现残余结石,均使用胆道镜或逆行胰胆管切开取石术(EST)取尽结石。其余患者无严重并发症发生。结论腹腔镜下胆总管切开取石术具有微创、安全的优点,在严格把握手术适应证和熟练掌握腔镜基本功的前提下,是值得推广的临床治疗胆总管结石的手术方式。

Objective To explore the advantages,methods,indications of LCBDE,and the necessary conditons of common bile duct drainage after surgery. Methods Using laparoscopic incision common bile duct,gall stones clamp special stones and/or in the open-duct stones. Then analysized the operation and characteristics retrospectively. Results 21 patients were successfully completed in laparoseopie incision stones in common bile duct, without conversion to open, the average operation time was 145 min,the average bleeding was75ml, the average hospitalization was 6d. Bile leakage occurred in three cases, recovered 4 days after conservative treatment; five cases were found remnants of stone,using the duct or retrograde cholangiopancreatography cut stones of （EST） to take calculus all out. There was no serious complications occurred on the remaining patients. Conclusion LCBDE has advantages of minimally invasive,seeurity,under the premise of grasping the operation indications strictly and mastering basic skills of Endoscopic,it is a clinical method of surgery which is worth to promote.