完全腹腔镜联合胆道镜治疗胆总管结石

Complete laparoscopic combined with choledochoscope in treating choledocholithiasis

目的探讨完全腹腔镜联合胆道镜治疗胆总管结石的临床应用价值。方法自2004年11月至2009年12月间,影像学检查确诊为胆总管结石的患者109例。经胆囊管胆道镜探查胆总管取石术68例;胆总管切开胆道镜探查取石胆总管一期缝合术26例;胆总管切开胆道镜探查加T管引流术15例。结果 109例均顺利完成手术,无中转开腹。胆总管切开胆道镜探查取石胆总管一期缝合术中19例发生短暂胆漏,经3～6d引流后胆漏消失。其余患者术后3～10d出院,随访6～9个月,复查无胆道残留结石发生。结论完全腹腔镜联合胆道镜治疗胆总管结石具有微创手术的优点,安全有效,可以替代传统的胆总管切开探查、T管引流术。

Objective To evaluate the clinical value of fully laparoscopic combined with choledochoscope in treating choledocholithiasis. Methods From November 2004 to December 2009,109 calculus of common bile duct cases conformed by imaging diagnosis were explored by laparoscopic combined with choledochoscope. Among them, laparoscopic transcystic common bile duct exploration and lithotomy 68 cases,primary suture of the common bile duct after laparoscopic biliary exploration and lithotomy 26 cases, laparoscopic choledocholithotomy T-tube drainage 15 cases. Results All patients were operated successfully without conversion to open surgery. There were 19 cases suffered from short bile leakage among 26 cases of primal3, suture of the common bile duct after laparoscopic biliary exploration and lithotomy. The bile leakage disappeared after 3-6 days draining. The postoperative hospitalization was 3-10 days. All the cases were followed up for 6-9 months without residual stone. Conclusions Complete laparoscopic combined with choledochoscope in treating choledocholithiasis is a minimally invasive, safe and effective surgical method. It can replace the traditional surgery （choledocholithotomy and T-tube drainage）.