腹腔镜联合术中胆道镜胆总管探查取石65例临床研究

Laparoscopy combined with intraoperative choledochoscope in common bile duct exploration experience in 65 cases

目的总结腹腔镜术中胆道镜胆总管探查取石的手术方法。方法回顾性分析郑州市中医院普外科2009年1月至2013年12月间行腹腔镜术中联合胆道镜胆总管探查取石65例临床资料。结果 65例中37例(56.9%)胆总管切开联合胆道镜探查取石,平均手术时间98min,术后平均住院时间11d,一期缝合28例,T管引流9例,取出结石最大直径2.3cm,最多取出结石21枚;28例(43.1%)胆道镜经胆囊管行胆总管探查取石,平均手术时间126min,术后平均住院时间7d,取出结石最大直径6mm,取出结石最多7枚。术后无严重操作相关并发症。结论腹腔镜下胆总管切开联合胆道镜探查取石,能够达到与开腹手术相同的效果,具有创伤小、并发症少、恢复快等优点。胆道镜经胆囊管行胆总管探查取石术中给予胆道镜满意的纵向支持是完成手术的前提,又避免胆道切开的损伤,对于胆总管小结石取出尤为适合。

Objective To summarize the operation method of choledochoscope incommon bile duct exploration in laparoscopic surgery. Methods Retrospective analysis of clinical data of 2009 January to 2013 December in Department of general surgery,Zhengzhou Hospital of traditional Chinese medicine for therapeutic laparoseopy combined with choledoehoscopy for bile duct exploration 65 eases. Results Among the 65 cases, 37 cases （56. 9% ） common bile duct incision combined with cholangioscopy stone, the average operation time was 98min, the average postoperative hospital stay 11 days, stage one suture in 28 cases, T tube drainage in 9 cases, remove the stones out the maximum diameter of 2. 3cm, up to 21 stones （43.1%） ; 28 cases of biliary bile duct exploration through cystic duct ,the average operation time was 126min,the average postoperative hospitalization time was 7 days, remove the stones maximum diameter 6mm, remove the stones up to 7. No serious procedure related complications after operation. Conclusion Laparoscopie common bile duct incision Lapa- roscopic common bile duct incision combined with cholangioscopy,can achieve the same effect with open surgery, has the advantages of small trauma,less complications and quick recovery. Biliary lithotomy of common bile duct exploration gives the longitudinal support choledochoscope satisfaction is the premise to complete the operation via the cystic duct ,bile duct incision and avoid the damage. It is particularly suitable for small common bile duct stone extraction.