腹腔镜胆总管探查治疗胆囊切除术后复发或残留胆总管结石的临床疗效

Clinical efficacy of laparoscopic common bile duct exploration for recurrent or residual common bile duct stones after cholecystectomy

目的:探讨腹腔镜下胆总管探查(LCBDE)治疗胆囊切除术后复发或残留胆总管结石的临床疗效。方法:回顾性分析2012年4月—2015年6月52例行LCBDE治疗的胆囊切除术后复发或残留胆总管结石患者临床资料。结果:52例患者中成功完成LCBDE 48例(92.3%),其余4例均因腹腔粘连致密而中转开腹手术。48例患者术中放置T管15例,行胆总管一期缝合33例;手术时间(102.6±19.5)min,术中出血量(38.6±12.7)m L,术后住院时间(4.2±2.5)d;术后发生轻微胆汁漏2例,拔T管后胆汁性腹膜炎1例,均经保守治疗痊愈;术后胆总管残留结石1例,于术后6周经T管窦道胆道镜下网篮取石治愈。结论:LCBDE治疗胆囊切除术后复发或残留胆总管结石成功率高,且微创、恢复快,推荐临床应用。

Objective： To assess the clinical ei cacy of laparoscopic common bile duct exploration（LCBDE） in treatment of recurrent or residual common bile duct stones at er cholecystectomy. Methods： The clinical data of 52 patients with recurrent or residual common bile duct stones after cholecystectomy undergoing LCBDE treatment from April 2012 to June 2015 were analyzed retrospectively.Results： Of the 52 patients, LCBDE was successfully performed in 48 cases（92.3%）, and the remaining 4 cases were converted to open surgery due to severe abdominal adhesion. Of the 48 patients, 15 cases underwent T-tube placement during operation, and 33 cases received primary common bile duct closure; the operative time was（102.6±19.5） min, intraoperative blood loss was（38.6±12.7） m L, and length of postoperative hospital stay was（4.2±2.5） d. Mild bile leakage at er operation occurred in 2 cases, and bile peritonitis occurred in one case at er Ttube removal, which were all resolved by conservative treatment; one case had remnant common bile duct stones at er operation, and they were extracted by choledochoscopic net basket via the T-tube sinus tract at 6 weeks at er operation.Conclusion： For recurrent or residual common bile duct stones at er cholecystectomy, LCBDE has high success rate with minimal invasion and fast recovery, so it is recommended to be used.