腹腔镜手术治疗胆总管末端嵌顿性结石17例报告

Laparoscopic surgery for calculi impacted at distal common bile duct:a report of 17 cases

目的：探讨腹腔镜处理胆总管末端嵌顿结石的最佳方式。方法：回顾分析2008年1月至2010年12月行腹腔镜胆囊切除术＋腹腔镜胆总管探查术术中发现并处理的17例胆总管末端嵌顿结石患者的临床资料。结果：本组2例胆道镜下见结石嵌顿于乳头,且结石较小,胆道镜直视下用纤维胆道镜前端将结石轻轻推入十二指肠;6例结石较大,嵌顿于胆总管下端,中转开腹取出结石;9例见结石嵌顿于胆总管末端及乳头,结石不大,置入22~24号＂T＂管引流,其中3例术后经＂T＂管瘘道取石,6例行内镜十二指肠乳头括约肌切开取石。术后胆漏2例,占12%,引流量平均30~40m l/d,术后5~8d经保守治疗治愈。17例患者均痊愈出院。术后均获随访,无胆管残余结石,胆道通畅无狭窄。结论：胆总管末端嵌顿性结石的处理,应根据胆道的局部解剖情况,患者的全身情况及术者技术水平,医院设备条件等综合判断,依据个体化原则,选择恰当的诊断和处理措施。

Objective：To investigate the best method of laparoscopic treatment for calculi impacted at distal common bile duct.Methods：Seventeen patients with calculi impacted at distal common bile duct underwent laparoscopic treatment from Jan.2008 to Dec.2010.Their clinical data were analyzed restrospectively.Results：Laparoscopic and choledochofiberscopic surgeries were performed successfully on 2 patients.Six procedures were converted to laparotomy for large size of the calculi.T-tube drainage was performed in 9 cases in order to remove the calculi（three cases through sinus tract and six through endoscopic sphincterectomy）.All the patients recovered smoothly and no recurrence was detected during the follow-up.Conclusions：Laparoscopic surgery for calculi impacted at distal common bile duct shoud be treated according to the biliary anatomy,general condition of patients and surgeons＇ technology.Individual treatment is recommended.