腹腔镜胆总管探查术诊治胆总管结石100例报告

Laparoscopic common bile duct exploration in the diagnosis and treatment of choledocholithiasis: a report of 100 cases

目的:总结腹腔镜胆总管探查术诊治胆总管结石的经验教训,进一步探讨手术技巧及胆总管一期缝合的可行性。方法:回顾分析100例腹腔镜胆总管结石手术的临床资料,根据患者胆总管结石数量、大小,采用经胆囊管探查、经胆囊管胆总管交界处切开探查、直接胆总管切开探查三种处理方式。结果:经胆囊管探查7例,经胆囊管胆总管交界处切开探查25例,胆总管切开探查68例,其中放置T管7例,93例行胆总管一期吻合。术后发生胆漏5例,1例保守治疗,3例再次手术T管引流,1例行ERCP治疗。T管无法夹管1例,ERCP发现十二指肠乳头癌行胰十二指肠切除术。术后随访3个月～9年,随访率68%,胆总管结石复发4例,其中2例行EST治疗好转,2例保守治疗。结论:胆总管结石行腹腔镜手术应采取个体化的治疗方式,初期开展容易发生严重并发症,应严格把握手术准入制度,适当延长培训时间,以增加手术安全性。

Objective：To summarize the lessons and experiences of laparoscopic common bile duct exploration in the diagnosis and treatment of choledocholithiasis, and discuss the operative skills and feasibility of primary suture of common bile duct. Methods： The clinical data of 100 patients who underwent ]aparoscopic common bile duct exploration were analyzed retrospectively. Exploration via cystic duct, via junction of cystic duct and common bile duct as well as via common bile duct were conducted according to the size and quantity of stones. Results ： Common bile duct exploration via cystic duct was conducted in 7 cases, via the junction of cystic duct and common bile duct in 25 cases, via common bile duct in 68 cases. T tube was placed in 7 patients, primary suture was performed in the rest 93 patients. Postoperative bile leakage was found in 5 patients, of whom 1 patient underwent conservative treatment, 3 patients underwent reoperation for T tube drainage, and 1 patient underwent ERCP. T tube could not be clipped in 1 patient, then this patient underwent pancreatieoduodenectomy for duodenal papillary carcinoma which was detected by ERCP. The patients were followed up for 3 months to 9 years with a follow-up rate of 68%. Recurrence of choledocholithiasis was found in 4 patients ,2 patients of whom underwent EST,the rest 2 patients underwent conservative treatment. Conclusions： Individualized treatment should be adopted in laparoscopic common bile duct exploration, and severe complications are frequently encountered in the beginning. Strict admission system and longtime training are essential to guarantee the safety of the operations.