腹腔镜联合胆道镜治疗胆总管结石68例临床分析

Laparoscopy combined with choledochoscopy in the treatment of choledocholithiasis:clinical analysis of 68 cases

目的:探讨腹腔镜胆总管探查术治疗胆总管结石的临床技巧。方法:回顾分析2013年1月至2016年9月为68例胆总管结石患者行腹腔镜胆总管探查术的临床资料。结果:64例成功完成腹腔镜胆总管探查术,成功率94.1%;其中6例行乳头括约肌切开取石术(endoscopic sphincterotomy,EST)未成功,改行腹腔镜胆总管探查术;2例较大结石(>1.5 cm),开腹胆道取石钳及网篮均无法取出,采用钬激光碎石成功。4例中转开腹,均为腹腔致密粘连,胆总管无法显露。手术时间60~150 min,平均(80.2±18.6)min。术后2例发生胆漏,保守治疗2~6 d痊愈。术后住院10~14 d,平均(10.4±6.6)d。术后4~6周拔除T管,1例术后2周经T管造影检查证实残留结石1枚,6周后经窦道胆道镜取出结石。62例患者术后随访6~12个月,无肝内外胆管狭窄、急性胰腺炎等并发症发生。结论:腹腔镜胆总管探查取石术是安全、可行、有效的,熟练掌握软硬镜技术及术中细致的操作是手术成功的关键。

Objective：To discuss the clinical skill of laparoscopic common bile duct exploration in the treatment of choledocholithiasis.Methods：In the period of Jan.2013 to Sep.2016, 68 patients with choledocholithiasis were treated by laparoscopic common bile duct exploration and the therapeutic effects were reviewed.Results：The 64 cases were successfully treated by laparoscopic common bile duct exploration,the success rate was 94.1% （64/68）,among them 6 patients failed to be treated by endoscopic sphincterotomy and were cured by laparoscopic common bile duct exploration.2 patients with large calculi （〉1.5 cm）,which could not be taken out using laparotomy forceps and basket,successfully underwent holmium laser lithotrity.4 patients were converted to open surgery because peritoneal adhesion was compact and common bile duct could not be exposed.The operation time was 60-150 min with the average of （80.2±18.6） min.2 cases of postoperative bile leakage were treated conservatively and were cured in 2-6 d.The postoperative hospital stay was 10-14 d with the average of （10.4±6.6） d.After surgery T tube was removed in 4-6 weeks.1 case of postoperative residual calculi was confirmed by T-tube cholangiography after 2 weeks,the stone was taken out by choledochoscopy through sinus tract after 6 weeks.62 patients were followed up for 6-12 months,no intrahepatic and extrahepatic bile duct stricture,acute pancreatitis or other complications occurred.Conclusions：Laparoscopic common bile duct exploration is a safe,feasible and effective method,a good understanding of flexible and rigid endoscopic technology and careful operation are the key to successful operation.