腹腔镜经胆囊管胆总管探查取石术的临床应用

Laparoscopic Trans-cystic Bile Duct Exploration in the Management of Choledocholithiasis

目的探讨腹腔镜经胆囊管胆总管探查取石术在胆囊结石合并胆总管结石中的应用价值。方法 2013年1月~2014年6月,行经胆囊管腹腔镜胆总管探查取石术52例。结果 50例（96.2%）完成腹腔镜经胆囊管胆总管探查取石术,取出结石76枚,直径0.3~1.5 cm,（0.62±0.43）cm,手术时间55~180 min,（119.3±37.3）min。2例经胆囊管进胆道镜失败,改术中或术后十二指肠镜取石。中转开腹率1.9%（1/52）,残余结石率2.0%（1/50）,并发症发生率6.1%（3/49）。术后住院时间1~14 d,（5.0±2.8）d,住院费12 490.3~33 303.3元,（21 731±5294.1）元。结论腹腔镜下经胆囊管胆总管探查取石术治疗胆囊结石合并胆总管结石微创、经济、有效,并且保护乳头括约肌功能。

Objective To evaluate the clinical outcome of laparoscopic trans-cystic bile duct exploration（ LTCBDE） in the management of choledocholithiasis. Methods A retrospective analysis was conducted on clinical data of 52 cases of LTCBDE between January 2013 and June 2014 in our hospital. Results The LTCBDE was successfully accomplished in 50 cases（ 96. 2%）,with 76 stones 0. 3- 1. 5 cm in diameter（ mean,0. 62 ± 0. 43 cm） drawn from the common bile duct. The time of operation was 55-180 min（ mean,119. 3 ± 37. 3 min）. The percentages of reversion to open surgery,residual stones and morbidity were 1. 9%（ 1 /52）,2%（ 1 /50）,and 6. 1%（ 3 /49）,respectively. The length of post-operative hospital stay was 1- 14 d（ mean,5. 0 ±2. 8 d）. The total hospitalization charge was 12 490. 3- 33 303. 3 yuan（ mean,21 731 ± 5 294. 1 yuan）. Conclusion Laparoscopic trans-cystic bile duct exploration in the management of choledocholithiasis is minimally invasive and cost-effective,with advantages of preserving the intact of Oddi＇s sphincter.