腹腔镜下胆总管末端狭窄支撑术117例报告

Laparoscopicstents Supporting for the Stenosis of the Common Bile Duct Termination Region: A Report of 117 Casses

目的总结运用腹腔镜下胆总管末端狭窄支撑术的治疗经验。方法采用腹腔镜胆总管切开探查、取石网取石或液电碎石直至取净肝外胆管结石,在斑马导丝引导下用逐级扩张导管和(或)球囊导管对胆总管末端狭窄进行扩张,并对胆总管末端梗阻为主的良恶性狭窄病人有选择地放置塑料支架或自膨式金属胆管支架。结果本组117例患者中109例(93.2%)手术获成功,即术后无胆漏、支架位置正确、引流通畅、黄疸减轻或消退。1例中转开腹,2例胆漏,1例残石,2例支架位置错误,2例术后死亡(并发症总发生率6.8%)。结论只要选择合适的病例,腹腔镜下胆总管末端狭窄支撑术处理胆总管末端梗阻为主的良恶性狭窄有效、可行、简便、较安全。

Objective To summarize the experience on laparoscopic stents supporting for stenosis of the common bile duct termination region （LCBDS）. Methods It was used of laparoscopic common bile duct exploration, net stone or electrohydraulic lithotripsy to take a clean of extrahepatic bile duct stones. It was dilated that the Annular stenosis or tubular stricture of the common bile duct termination region by dilatable catheter, the balloon and zebra guidewire in laparoscopic common bile duct exploration. After that, laparoscopic stents supporting for the stenosis of the common bile duct termination region by Plastic stent or serf-expandable metallic stents. Results In 109 cases（93. 2% ） had completed successful the dilatation of the stenosis and biliary drainage to reach the preestablished object in total 117 patients of the terminal CBD stenosis of stones and metastatic periampulla carcinoma. One patient changed laparoscopic operation into open abdominal operation. Two patients had leaked the bile juice. One patient had a large number of residual stones in the left intrahepatic duct . The Wallstent of 2 patients is fail. Two patients had died of the functional failure of the liver and the kidneys operated 15 days later （ the general incidence of complications 6. 8% ）. Conclusion If patients are suitable, LCBDS is feasible, simple and safety that the stents supporting of the terminal CBD stenosis of benign and malignancy.