经皮胆总管探查内置管内引流术治疗胆道多发结石

Laparoscopic percutaneous common bile duct exploration with internal draining tube placement for the treatment of cholelithiasis

目的探讨经皮胆总管探查、内置管内引流手术治疗胆道多发结石的临床效果。方法回顾性分析2002年3月至2010年9月解放军第四五一医院收治的962例胆总管结石患者的临床资料。全组患者均行LC，采用自制器械行胆总管探查，将内置管放置在胆总管和十二指肠内以内引流胆汁，通过十二指肠注水的膨抽试验确认内置管放入十二指肠，术后30d经十二指肠镜拔出内置管。结果全组患者中成功完成经皮胆总管探查、内置管内引流手术864例，中转开腹42例，中转腹腔镜胆总管T管外引流56例。864例患者手术时间为20～72min，平均手术时间为（36±18）min；术后住院时间为（6．6±2．1）d；术后出现腹膜后腔脓肿经局部引流治疗痊愈2例，出现胆汁漏经保守治疗痊愈32例；术后30d 862例患者通过B超检查随访，其中603例发现胆总管内置管影像，经十二指肠镜拔出内置管，1例内置管回缩胆总管经EST取出，258例内置管自然脱落。864例患者术后随访1—3年无胆管狭窄，26例胆总管复发结石经EST取出。结论经皮胆总管探查、内置管内引流手术是治疗胆道多发结石的一种安全而简便的微创方法。

Objective To investigate the efficacy of laparoscopic percutaneous common bile duct exploration （LPCBDE） with internal draining tube placement for the treatment of cholelithiasis. Methods The clinical data of 962 patients with choledocholithiasis who were admitted to the No. 451 Hospital of PLA were retrospectively analyzed. A self-made internal draining tube was placed in the common bile duct and duodenum to drain bile internally. The correct position of the internal draining tube was comfirmed by injecting water into and draining water from duodenum. The internal draining tube was pulled out with the help of duodenoscope at 30 days after the operation. Results LPCBDE with internal draining tube placement was successfully performed on 864 patients. Forty-two patients were transferred to open surgery, and 56 patients were transferred to receive LPCBDE with T-tube drainage. The mean operation time was （36 _＋ 18） minutes （ range, 20-72 minutes）, and the length of postoperative hospital stay was （6.6±2.1 ） days. Two patients were complicated with retroperitoneal abscess and they were cured by puncture and drainage, 32 patients were complicated with bile leakage and they were cured by conservative treatment. A total of 862 patients were followed up by B ultrasound at 30 days after the operation. The internal draining tube which was confirmed in the common bile duct was extracted with duodenoscope in 603 patients ; the internal draining tube which was drawn back in 1 patient was removed with endoscopic sphincterotomy （EST） ; the internal draining tube was removed naturally in 258 patients. The follow-up period ranged from 1 to 3 years, 26 patients had recurrent cholelithiasis and they were treated by EST. Conclusions LPCBDE with internal draining tube placement is a safe and minimally invasive method for the treatment of cholelithiasis.