胆囊管结石的腹腔镜治疗体会

Treatment experience by laparoscope for cystic duct calculi

目的 探讨腹腔镜下治疗胆囊管结石的效果。方法 回顾性分析76例胆囊管结石患者的临床资料和手术过程。结果 76例患者中62例成功实施腹腔镜胆囊切除术。术中出血量15~150 ml,平均术中出血量55 ml。术后出现胆汁渗漏2例,1例为胆囊床渗漏,72 h拔管,1例胆漏持续4周,4周后造影未见胆道系统显影,拔除引流管治愈。其余患者术后无严重并发症及死亡。术后随访12个月,未发现胆管狭窄及残余结石。结论 腹腔镜处理胆囊管结石是安全可行的。胆囊切除中谨慎处理胆囊管防止结石遗漏,灵活运用腹腔镜技术是手术成功的关键,值得临床推广应用。

Objective To investigate effect of laparoscopic treatment for cystic duct calculi.Methods Clinical data of surgical process of 76 patients with cystic duct calculi were retrospectively analyzed. Results All the 62 cases among 76 patients received successful LC. Their intraoperative bleeding volume was 15-150 ml, with the average volume as 55 ml. There were 2 cases with postoperative bile leakage, and 1 case with gallbladder bed leak. They received extubation in 72 h, and 1 case had bile leakage for 4 weeks. Radiography after 4 weeks showed no biliary imaging in this case, which was cured after extubation of drainage tube. There were no severe adverse reactions or death in the other cases. Follow-up lasted for 12 months after operation, and that showed no bile duct stricture or retained calculi. Conclusion Laparoscope is feasible and safe in treatment of cystic duct calculi. Detailed management of cystic duct to prevent calculi leakage and flexible implement of laparoscope are the keys to successful operation. This method is worthy of clinical promotion and application.