腹腔镜胆囊管结石及胆囊管残株结石的处理体会

Clinical experiences on laparoscopic treatment of cystic duct stones and cystic duct stump stones

目的:总结胆囊管结石的术前诊断及腹腔镜胆囊切除(laparoscopic cholecystectomy,LC)、胆总管探查术的处理措施与技巧,并探讨LC术后早期胆囊管残留结石行腹腔镜胆囊管残株切除术的手术方式、技巧与注意事项。方法:回顾分析27例LC、2例腹腔镜胆总管探查术、2例LC术后早期腹腔镜胆囊管残株切除术的临床资料。结果:31例均顺利完成手术,无中转开腹。LC术中1例肝总管针孔样损伤,用4-0可吸收线缝合修补一针,术后无胆漏发生。结论:胆囊管结石较常见,术前、术中容易漏诊,对于术后早期发生的胆囊管残留结石可行腹腔镜胆囊管残株切除。

Objective：To summarize the clinical experience on preoperative diagnosis of cystic duct stones as well as the tech- nique and skills of laparoscopic cholecystectomy （LC） and common bile duct exploration, and to discuss the approach, skills and the note of laparoscopic resection of cystic cluct stump for residual stones after LC. Methods： The clinical data of 27 patients who underwent LC,2 patients who underwent laparoscopic common bile duct exploration,and 2 patients who underwent laparoscopic resection of cystic duct stump shortly after LC were analyzed retrospectively. Results：The： operationa.were conducted successfully in all patients with no conversion to open surgery. One patient suffered from tiny injury of ductuli hepaticus communis during LC, and the injury was repaired by suture with 4-0 abi^rbable thread. No postoperative bile leakage occurred. Conclusions：Cystic duct stone is a kind of common dis- ease which can be easily misdiagnosed preoperatively and intraoperatively. Laparoscopic resection of cystic duct stump can be used for the treatment of residual stones shortly after LC.