腹腔镜胆总管探查术22例临床分析

Clinical Analysis of Laparoscopic Common Bile Duct Exploration in 22 Cases

目的探讨腹腔镜胆总管探查术（laparoscopic common bile duct exploration,LCBDE）的可行性及临床价值。方法回顾性分析2009年4月-2010年10月22例腹腔镜胆总管探查取石术的临床资料。结果 22例患者均在腹腔镜下成功完成胆总管切开取石术,无中转开腹,手术时间100220 min,平均142 min,术中出血20100 ml,平均40 ml。22例均行T管引流术。1例患者术后出现轻微胆漏,保守治疗5 d后痊愈,其余患者无胆漏及其它并发症发生。术后住院时间611 d,平均7.8 d。术后T管造影均未发现胆管内有残留结石。结论在严格把握手术适应证和熟练掌握腔镜基本功的前提下,腹腔镜胆总管探查术治疗胆总管结石是是一种创伤小、恢复快、安全可行的微创手术。

Objective To explore the feasibility and the clinical value of laparoscopic common bile duct exploration（LCBDE）.Methods The clinical data of 22 patients who underwent LCBDE from April 2009 to October 2010 in our department was analyzed retrospectively.Results The LCBDE was successfully completed in 22 cases,no case was converted to open operation.The operating time ranged from 100 to 220 min（mean 142 min）,and the intraoperative blood loss ranged from 20 to 100 ml（mean 40 ml）.T-tube drainage was conducted in all 22 cases.Bile leakage occurred in one case,recovered 5 days after conservative treatment,there was no bile leakage or other complications occurred in other patients.The postoperative hospitalization was 6-11 d（mean 7.8 d）.No residual stone were found by postoperative T-tube cholangiography in 22 cases.Conclusion LCBDE was feasible alternative for the management of common bile duct stones with microtrauma,safety and tacho-recovery,under the premise of grasping the operation indications strictly and mastering basic skills of endoscopic,it was a clinical method of surgery which was deserved to be popularized