腹腔镜联合纤维胆道镜治疗肝外胆管结石

Application of laparoscope combined cholangiofiberscope in the treatment of extrahepatic biliary calculi

目的总结腹腔镜联合胆道镜治疗肝外胆管结石的临床应用体会。方法回顾分析我院在2010年8月～2013年10月的27例胆道结石患者联合应用腹腔镜纤维胆道镜微创治疗的临床资料。结果本组27例均在全麻下行腹腔镜胆囊切除术及纤维胆道镜下胆总管探查及取石术。术中胆总管I期缝合12例，总管留置T管引流15例。所有手术均顺利完成，无中转开腹手术。手术平均时间是85min。术后平均住院时间是7．4d。在胆总管Ⅰ期缝合12例中，1例术后出现少量胆漏。经延长引流时间10d后治瘛；而胆总管留置T管引流15例中，术后发现胆总管结石残留2例，手术后8W经T管窦道采用纤维胆道镜取石成功。术后无其它严重并发症发生。结论腹腔镜联合纤维胆道镜治疗胆道结石安全有效。

Objective To summarize the experience in treating extrahepalic biliary calculi with laparoseopic combined eholangiofiberseope. Methods From August 2010 to October 2012, the clinical data of 27 cases with extrahepalic biliary calculi undergoing laparoscope combined cholangiofiberscopy were analyzed retrospectively. Results The laparoscopic cholecystectomy and choledochotomy with exploration and choledocholithotomy by the cholangiofiberscope were performed in all cases. Among them, primary suture of common bile duct was in 12 cases and indwelling T tube drainage was in 15 cases. The operations were completed smoothly in all cases. No one case was transferred to open abdominal surgery. The average operative time was 85 minutes. The average postoperative hospitalization time was 7.4 days. In the 12 cases of primary suture of common bile duct, one case occurred mild biliary leakage and that case was cured by prolonging drainage time for 10 days. In the 15 cases of indwelling T tube drainage,the postoperative residual stones were found by T bube cholangiography in 2 cases. These residual stones were removed via T tube sinus with cholangiofiberscope 8 weeks after operation. No postoperative hemobilia, incisional infection and obvious abdominal infection were found. Conclusion Laparoscope combined cholangiofiberscope is a safe and effective method for the treatment of extrahepalic biliary calculi.