腹腔镜胆道探查取石术应用体会

Application experiences of laparoscopic biliary duct exploration

目的探讨腹腔镜胆道探查取石术的可行性。方法回顾性分析38例腹腔镜胆道探查取石病人的临床资料，对手术适应证、手术方式及并发症的预防进行总结。结果38例病人中，胆总管结石36例，胆总管扩张未见结石2例。同时合并胆囊结石34例，合并有肝内胆管结石2例，合并肝囊肿2例。术前全部病人均行B超和MRCP检查。37例（97．4％）完成腹腔镜胆道探查取石术，1例因致密粘连中转开腹手术，36例同时行腹腔镜胆囊切除，2例同时行肝囊肿开窗引流术。14例行胆总管一期缝合，24例行胆总管T管引流。手术时间为1～4h，平均1．5h。住院时间3～12d，平均5．5d。术后发生胆瘘2例，胆总管下端残余结石1例，胸腔积液1例。结论腹腔镜胆道探查术安全、微创、美观，可明显缩短住院时间，是一种可选择的治疗方法。

Objective To explore the feasibility of laparoscopic exploration of common bile duct lithotomy. Methods Retrospective analyses of clinical data were preformed for 38 cases of laparoscopic common bile duct exploration for stone. And their surgical indications, approaches and complications were summarized. Results Among them, there were biliary calculus of common bile duct （n = 36） and bile duct dilatation without stone （n = 2）. The concurrent conditions included gallbladder stone （n = 34）, intrahepatic bile duct stone （n = 2） and hepatic cyst （n = 2）. Before operation, all patients received type B ultrasound and MRCP examination. Among 37 patients （97. 4% ） with laparoscopic biliary duct exploration, there were laparotomy due to dense adhesion （n = 1）, laparoscopic cholecystectomy （n = 36） and hepatic cyst open drainage （n = 2）. Primary suture of common bile duct （n = 14） and common bile duct T tube drainage （n = 24） were performed. The average operative dura- tion was 1.5 （1-4） hours. And the average hospital stay was 5.5（3-12） days. The postoperative complications included biliary fistula （n = 2）, bile duct residual stone （n = 1） and pleural effusion （n = 1）. Conclusions Laparoscopic common bile duct exploration is safe and mini-invasive. And it can significantly shorten the time of hospitalization.