再次腹腔镜手术处理胆管残石和胆管再生结石

Laparoscopic Management of Retained or Recurrent Common BileDuct Stones after Laparoscopic Biliary Operations

目前，对腹腔镜胆囊切除术（ＬＣ）后胆管残石及腹腔镜胆道探查术（ＬＣＤＥ）后胆管再生结石的处理，多采用经内镜乳头切开（ＥＳ）或者开腹胆道探查（ＯＣＤＥ）。我院从１９９７年６月到１９９９年２月，对５例ＬＣ术后胆管残石和２例ＬＣＤＥ术后胆管再生石，选用再次ＬＣＤＥ处理。两次手术间隔１天到５年。术中一次取净结石。２例术后安置Ｔ管，５例胆管一期缝合。Ｔ管于术后６周拔除，并经Ｔ管窦道行胆道镜检查。胆管一期缝合者，术后３月行静脉胆道造影（ＩＶＣ），均未发现残石和狭窄。结论：腹腔镜手术的微创优越性，使再次腹腔镜手术处理胆管残石和再生石成为可能。

Postoperative endoscopic sphincterotomy (ES) and open common bile duct exploration (OCDE) are commonly used to remove retained/ recurrent common bile duct stones (CBDS) after laparoscopic cholecystectomy (LC) or laparoscopic common bile duct exploration (LCDE). With the development of laparoscopic experience, reoperation of LCDE similar to open procedure is a new attractive option to select for retained/recurrent CBDS after laparoscopic biliary operations. Between June 1997 and February 1999, Five patients with retained CBDS after LC and 2 patients with recurrent CBDS after LCDE were demonstrated at ERC. The two admissions were between 1 day to 5 years. There were 5 men and 2 women with median age of 51 years (rang 15 to 77 years). Clearance of bile duct was complete in all 7 patients (100%) by means of reoperation of LCDE. 2 patients with T-tube insertion, T-tubes were extracted 6 weeks after LCDE and followed choledochoscopy down the T-tube track. Five patients had primary duct closure after the bile duct being cleared. Intravenous cholangiography (IVC), 3 months after LCDE, proved that there were no signs of retained CBDS or bile duct stricture. There was only one mild complication of port site infection . In conclusion, we believe that retained/ recurrent CBDS after LC or LCDE can be managed by reoperation of LCDE safely, effectively in expert hands.