腹腔镜联合术中胆道镜经胆囊管胆道探查取石技巧(附292例分析)

The surgical skills of transcystic approach with intra-operative choledochoscope in laparoscopic common bile duct exploration:an analysis of 292 cases

目的总结腹腔镜术中胆道镜经胆囊管胆道探查取石的手术技巧。方法回顾性分析北京友谊医院普外科2006年12月至2009年4月间行腹腔镜经胆囊管胆道探查术292例的临床资料。结果所有病例均通过胆囊管缝合牵引使胆道镜获得满意支撑。206例(70.5%)可直接完成网篮取石,其中83例通过超细胆道镜完成。另86例应用胆囊管球囊扩张、汇入部微切开、内镜下碎石等技术辅助完成经胆囊管取石。全组病例平均手术时间(92.00±37.24)min、术后平均住院日(2.52±1.91)d,无严重操作相关并发症发生。结论腹腔镜术中给予胆道镜满意的纵向支撑是完成经胆囊管胆道探查取石的先决条件,综合运用各种技巧可提高手术成功率并获得良好的治疗效果。

Objective To summarize the surgical skills of laparoscope transcystic common bile duct exploration （LTCBDE）. Methods Retrospectively analyze the clinical materials of 292 cases of LTCBDE between Dec 2006 and Apr 2009 in our hospital. Results We support the flexible choledochoscope with the guide suture on the cystic duct in all cases. 206 cases （70.5%） can retrieval the calculi with wire basket via Tran cystic approach directly, among them 83 cases with a small-caliber choledochoscope. The other 86 cases under the help of cystic duct balloon dilation, mini-incision at the confluence of CBD and cystic duct, or transcystic lithotripsy. The mean operative time and post-operative hospital stay were （92.00 ± 37.24） minutes and （2.52 ±1.91） days, without severe procedure-related complication. Conclusion Support of the flexible choledochoscope on axial direction is prerequisite for the transcystic approach. Integrative use of variety skills is helpful to more transcystic approach and eventually benefit for the clinical effect.