术后胆总管再发结石腹腔镜探查术48例临床分析

Clinical analysis of laparoscopic common bile duct exploration in 48 cases after laparoscopic cholecystectomy

目的总结腹腔镜胆囊切除术(LC)后腹腔镜胆总管切开探查治疗胆总管结石的经验及效果。方法回顾性分析48例LC后胆总管再发结石,行腹腔镜胆总管切开探查治疗胆总管结石的临床资料。术前均行影像检查包括B超、CT、MRI或MRCP,了解结石大小、量多少、分布情况及胆总管直径、走行。结果 43例成功手术。2例顺利手术后出现胆漏,经腹腔通畅引流3～5 d后痊愈。3例因腹腔粘连、解剖不清改中转开腹。1例术后残石行胆道镜取石。手术时间40～130 min,平均时间80 min,出血5～130 ml,平均约30 ml。住院时间7～14 d,平均10 d。术后6周常规T管造影拔管,无不良并发症发生。结论 LC后腹腔镜胆总管切开探查治疗胆总管结石是一种创伤小、恢复快、安全可靠的微创手术。

Objective To Summarize the experience and effects of laparoscopic common bile duct exploration （LCBDE）after laparoscopic cholecystectomy（LC）. Methods The clinical data of 48 patients who underwent LCBDE after LC was analyzed retrospectively. All cases underwent Pre-operative imaging including B ultrasound, CT, MRI or Magnetic Resonance Cholangiopancreatography （MRCP）, to understand the stone size, quantity, distribution and the diameter and running of the common bile duct. Results The LCBDE was successfully completed in 43 cases. Bile leakage occurred in 2 cases, recovered 3 to 5 days after abdominal cavity unobstructed drainage. 3 in 48 cases have been converted to open surgery for abdominal adhesion. 1 case of residual bile stones after LCBDE was cured by choledochoscopic exploration, The operating time ranged from 40 to 130 minutes （ mean 80 minutes） , and the intraoperative blood loss ranged from 50 to 130 ml （ mean 30 ml）. The hospitalization ranged from 7 to 14 days （ mean 10 days）. T-tube was drawn 6 weeks after operation,and without complications. Conclusion LCBDE after LC was feasible alternative for the management of common bile duct stones with microtrauma, safety and rapid recover.