经胆囊管超细胆道镜联合双频激光碎石治疗胆道结石

Laparoscopic Transcystic Common Bile Duct Exploration Combined with Superfine Choledochofiberscopy and Doublefrequency Laser Lithotripsy for Biliary Stones

目的 探讨腹腔镜下经胆囊管超细胆道镜（管径3.7mm）联合双频激光碎石术治疗胆道结石的安全性和可行性。方法 2011年8月～2013年6月，治疗胆囊结石合并胆道结石63例。行腹腔镜胆囊切除术，经胆囊管通过胆道镜工作通道，用双频双脉冲激光碎石技术将结石击碎，注水冲出或用取石网篮套出。结果 63例胆道结石均一次清除取出。无胆道损伤、胆漏。全组术后3个月复查B超或MRCP，未发现胆道残余结石、胆道狭窄。结论 腹腔镜下经胆囊管超细胆道镜联合双频激光碎石术直观，准确，方便，疗效确切，是治疗胆囊合并胆道结石的安全、有效的新方法。

Objective To evaluate the safety and feasibility of laparoscopic transcystic common bile duct exploration combined with superfine choledochofiberscopy and double-frequency laser cholelithotripsy for patients with complicated biliary calculus. Methods A total of 63 patients with cbolelitbiasis received laparoscopic transeystie common bile duct exploration combined with superfine choledochofiberscopy and double-frequency laser cholclithotripsy from August 2011 to June 2013. The patients with both hepatic duct and gall bladder stones received laparoscopic cholecystectomy followed by superfine choledochofiberscopy and doublefrequency laser eholelithotripsy. The stones were then removed by irrigation or a basket. Results All the stones in the total of 63 cases were removed completely in one operation without bile duct injury or biliary leakage. In the reexamination （ B-uhrasonography or MRCP） of all the cases 3 months after the surgery, no residual stones or bile duct stricture was observed. Conclusion Laparoscopic transcystic common bile duct exploration combined with superfine choledochofiberscopy and double-frequency laser cholelitbotripsy is a safe, effective, and accurate approach for complicated cholelithiasis.