腹腔镜下胆道镜经胆囊管行胆道探查取石术的体会

Laparoscopic choledochoscope via cystic duct bile duct exploration stone extraction

目的：探讨腹腔镜下胆道镜经胆囊管行胆道探查取石术（laparoscopic transcystic com-mon bile duct exploration,LTCBDE）时,采用先剥离胆囊再行取石操作方法的应用价值及术中操作技术要点。方法对2009年1月至2014年8月采用 LTCBDE 治疗胆囊结石合并胆管结石41例,其中17例采用先剥离胆囊再行 LTCBDE 手术操作的病人资料进行回顾性分析。结果本组17例均成功地完成了 LTCBDE 的手术操作,手术时间85～150 min,平均（110.3±11.2）min。术中出血量10～50 ml,平均（20.5±5.7）ml。所有病人均放置腹腔引流管,并于术后3～5 d 拔除。术后住院时间5～7 d,平均住院时间（7.8±0.5）d。术后均随访6～12个月,平均（8.0±0.5）个月,全组病例均恢复良好,无任何并发症的发生。结论对于胆囊结石合并胆管结石的微创治疗,腹腔镜下胆道探查取石术（LCBDE）是其治疗的首选术式。在部分条件适合的病例可以采用 LTCBDE 的手术方式,此可以达到更加微创的手术效果。其中采用先剥离胆囊再行取石操作的方法,可以最大限度地克服在取石操作时“胆道镜的插入困难和取石操作困难”这两大技术难点,值得推广应用。

Objective To explore the application value of initial removing gallbladder and subse-quent extracting stone for laparoscopic choledochoscope via cystic duct nephrolithotomy during laparo-scopic transcystic common bile duct exploration （LTCBDE）.Methods From January 2009 to August 2014,LTCBDE was applied for 41 cases of gallbladder stone with bile duct calculi.And 1 7 of them underwent initial gallbladder removal and subsequent stone extraction.Their clinical data were retro-spectively analyzed.Results All 1 7 cases successfully completed LTCBDE.The average operative du-ration was （1 10.25±1 1 .20）（85-1 50）min and the average intraoperative blood loss （20.50 ±5.70） （10-50）ml.All patients had drainage of abdominal cavity and the tube was taken out within 3-5 days after surgery.The average postoperative hospital stay was （7.82±0.54）（5-7）days and the average follow-up period （7.95 ±0.45 ）（6-12）months.All cases recovered well without any complication. Conclusions For select cases,LCBDE is a first-choice mini-invasive treatment of gallbladder stone with biliary calculi.And the practice of initial gallbladder removal and subsequent stone extraction shall overcome two major difficulties of choledochoscopic insertion and stone extraction.It is worthy of wider popularization.