腹腔镜胆总管探查的若干问题探讨

Discussion about laparoscopic bile duct exploration

目的探讨腹腔镜下胆总管探查取石术的优点、方法、适应证及术后胆总管Ⅰ期缝合术的必要条件等问题。方法分析60例胆总管结石患者(部分合并结石性胆囊炎)行腹腔镜胆总管切开取石术的术式及病例资料特点。结果 60例患者大部分在腹腔镜下成功完成胆囊切除、胆总管切开取石术,中转开腹3例,平均手术时间140 min,出血量微量,平均住院时间8 d。1例患者术后2 d T管脱落后出现胆漏,行EST及ENBD引流后治愈,1例术后造影后胆漏,保守治疗1周治愈,无二次手术;残余结石2例,2个月后经T管胆道镜结石取出,其余患者术后无严重并发症发生,造影无胆管狭窄随访8个月无结石复发。结论腹腔镜下胆总管切开取石术具有微创、安全的优点,在严格把握手术指征的前提下,是值得推广的临床治疗胆总管结石的手术方式。

【Objective】To discuss the advantage,method,indications of laparoscopic bile duct exploration,and the conditions of the primary closure.【Methods】To analysis the techniques and the indications of the 60 cases of common bile duct stones（some with cholesystistis and gallstone） who experienced laproscopic common bile duct ex-ploration（LCBDE） and stone extraction through choledochoscope.【Results】Most of the 60 cases had LCBDE and laparoscopic cholecystectomy（LC） successfully without the strictures and recurrent stones followed for 8 months ex-cept 3 open bile duct exploration and mean time is 140 min with minimum bleeding and mean hospital time 8 days,and 1 case of bile leakage because of the loose of the T-tube 2 days after LCBDE and cured with endoscopic sphincterotomy（EST） and endoscopic nasal bile drainage（ENBD）,and 1 case of bile leakage after cholangiography and cured spontaneously 1 week later without second operation,2 cases of retained stones extracted with choledo-choscope through matured T-tube tract.【Conclusions】LCBDE is safe and micro invasion,for strictly selected indi-cations,and should be a good selection for the common bile duct stones.