腹腔镜胆总管切开探查一期缝合治疗肝外胆管结石29例

Laparoscopic primary closure for the treatment of calculus of extrahepatic bile duct in 29 cases

目的探讨运用腹腔镜纤维胆道镜联合对肝外胆管结石进行切开探查取石及一期缝合的临床价值和治疗经验。方法回顾性分析增城市人民医院以及广东医学院附属医院2012年1月至2014年1月选择性运用腹腔镜联合胆道镜探查取石一期缝合治疗肝外胆管结石29例。结果 29例手术均获成功,无中转开腹;手术时间55-165 min,平均（95±22）min。术中出血5-45 ml,平均（20±11）ml。术后1-2 d拔除引流管,全部治愈出院,术后平均住院时间为（7.5±0.7）d。术后随访复查6-12个月,无残余结石、胆瘘及其他严重并发症。结论严格选择性运用腹腔镜联合胆道镜探查取石一期缝合切实可行、安全、可靠,有条件的医疗单位可对适宜的病例选择性地进行推广应用。

Objective To summarize the experience of laparoscopy combined with fibrocholedochoscopy for the treatment of calculus of extrahepatic bile duct. Methods Twenty-nine patients who underwent calculus of extrahepatic bile duct were studied from January 2012 to January 2014 in Zengcheng Peo-ple＇s Hospital and the Affiliated Hospital of Guangdong Medical College. Laparoscopic common bile duct ex-ploration（LCBDE） and choledochoscopy with primary closure were performed in those patients. Results There was no mortality and bile duct injury. None of them was converted to open surgery. Operation time ranged from 55 to 165 min, with an average of（95 ±22） min. Blood loss was 5 to 45 ml, with a mean of（20 ±11） ml.Tubes were removed 1 to 2 days postoperatively, and mean hospital stay was（7.5 ±0.7） d. A 6- to 12-month follow-up found no postoperative complications, such as biliary fistula and residual stone. Conclusion Laparoscopic primary closure of calculus of extrahepatic bile duct is safe and effective for the management of calculus of extrahepatic bile duct, and can be performed selectively in qualified hospitals.