腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的临床应用

Clinical Application of Laparoscopy Combined with Choledochoscopy for Common Bile Duct and Gallbladder Stone

目的探讨腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的合适方法。方法回顾性分析2007年10月～2012年4月188例腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石患者的临床资料。结果所有患者均成功腹腔镜切除胆囊，胆道镜取石169例成功，19例中转开腹。169例成功手术中，经胆囊管途径33例，经胆总管途径136例，胆总管一期缝合47例，13例出现胆瘘保持引流通畅3～6d后自愈。放置T管引流89例，其中85例T管造影未发现结石，顺利拔出T管，4例手术T管造影有结石残留，后经T管窦道胆道镜取出。结论腹腔镜联合胆道镜是治疗胆囊结石合并胆道结石的理想手术方式，但需根据患者病情采取合适的治疗方式。

Objective To investigate the most appropriate method in the treatment of common bile duct and gallbladder stone.Methods The clinical data of 188 patients undergoing laparoscopic common bile duct and gallbladder stone from October 2007 to April 2012 were analyzed retrospectively.Results All cases were successful laparoscopic resection in patients with gallbladder.Choledochoscope stone-free 169 cases were successful and 19 patients conversion to open operation was done.Of the 169 patients in whom minimal invasive surgery was successfully carried out,laparoscopic transcystic common bile duct exploration（TCBDE） was done in 33 patients and laparoscopic common bile duct exploration（LCBDE） in 136 patients.Primary closure of common bile duct（CBD） was carried in 47 patients,3 patients had a transient bile leak which healed spontaneously in 3 to 6 days.T-tube drainage was done in 89 patients.Retained stone was detected in 4 patients which was successfully retrieved through choledochoscopy.Conclusion Laparoscopic combined with choledochoscopy is an ideal operation method in treating common bile duct and gallbladder stone,but the choice of the procedure depends on the number, size of stons and the patient＇s choice. . I