腹腔镜联合胆道镜治疗肝外胆管结石的方法探讨

Laparoscopic combined with choledochoscopic operation in treatment of calculus of extrahepatic bile duct

目的:探讨腹腔镜联合胆道镜治疗肝外胆管结石的手术方法及临床经验。方法:回顾分析32例患者行腹腔镜联合胆道镜治疗肝外胆管结石的临床资料。结果:31例患者成功完成腹腔镜胆总管探查术,其中经胆囊管胆道镜取石5例,胆总管切开取石一期缝合16例,胆总管切开取石"T"管引流术10例;1例中转开腹。术后所有患者均治愈,4例并发胆漏,经腹腔引流3～7d痊愈;1例并发胆管残石,经"T"管窦道用胆道镜取出。结论:腹腔镜胆道探查治疗肝外胆管结石安全、有效;胆道探查术式应根据术者的手术经验及患者的实际情况做出不同的选择。

Objective：To investigate the method and clinical experience of laparoscopic combined with choledochoscopic operation in treatment of calculus of extrahepatic bile duct. Methods：Thirty-two cases with extrahepatic bile duct calculus underwent laparoscopy and choledochoscopy.Their clinical data were analyzed retrospectively. Results：Thirty-one cases were performed successfully,one case was converted to open operation.Five cases underwent choledochoscopic cholelithotomy through ductus cysticus,sixteen cases underwent laparoscopic common bile duct cholelithotomy and primary suture,and ten cases underwent laparoscopic common bile duct cholelithotomy and T-tube drainage.Four patients suffered from bile leakage,who were cured through abdominal drainage of 3-7d.One patient suffered from residual stones,which was removed by choledochoscopy through T-tube sin. Conclusions：Laparoscopic common bile duct cholelithotomy was a safe and efficient method for treatment of extrahepatic bile duct calculus.The style of exploration should be chosen by operation experience of the surgeon and the practical information of the patients.