腹腔镜联合胆道镜经胆囊管治疗胆囊结石合并胆总管结石的临床分析

Clinical analysis of laparoscopic combined with choledochoscope via the cystic duct for choledocholithiasis

目的探讨应用腹腔镜联合胆道镜经胆囊管行胆道探查治疗胆囊结石合并胆总管结石的临床效果。方法对2014年1月-2015年12月陕西省核工业二一五医院收治的52例胆囊结石合并胆总管结石患者行腹腔镜联合胆道镜经胆囊管胆道探查取石术,观察其临床效果。结果 52例患者中40例顺利完成手术,手术成功率为76.92%。7例改为腹腔镜下胆总管切开取石、T管引流术,5例中转开腹行胆总管切开取石、T管引流术,中转开腹率9.62%。43例患者一次取石成功,占82.69%;剩余9例患者行二次取石,其中行经胆囊管胆道探查取石术者8例,行腹腔镜下胆总管切开取石术者1例。所有患者术后留置网膜孔引流管,术后3~10 d拔除,1例行腹腔镜下胆总管切开取石患者术后出现胆漏,经保守治疗后康复。无胆道出血、胆道感染等发生,平均住院时间(8.24±2.52)d,所有患者均得到随访1年,B超及磁共振胰胆管造影检查肝内外未见结石残留,肝功能胆红素指标正常。结论腹腔镜联合胆道镜经胆囊管进行胆道探查取石术具有创伤小、患者恢复快、并发症少、安全等优点,临床应用需严格掌握其适应证。

Objective To explore the clinical application of laparoscopic transcystic common bile duct exploration.Methods From Jan2014 to Dec 2015,laparoscopic transcystic common bile duct exploration was performed in 52 cases of cholecystolithiasis.The therapeutic effects of cases were studied.Results Among them,40 cases were performed operation successfully.The success rate of operation was 76.92%.7 cases were changed to laparoscopic common bile duct incision exploratory stone operation.5 cases were performed common bile duct incision nephrolithotomy,and the transfer rate was 9.62%.43 cases were toke stone success at a time in all of patients.The success removed rate was 82.69%.The last 9 patients included 8 cases performed laparoscopic transcystic common bile duct exploration and 1 case performed laparoscopic common bile duct incision exploratory stone operation.All cases were placed abdominal cavity drainage tube pulled out after 3-10 days.Biliary leakage occurred in 1 patients performed laparoscopic common bile duct incision exploratory stone operation,and it was cured after conservative treatment.No biliary tract infection,biliary tract bleeding complications occurred.The average hospitalization time was（8.24±2.52） days.All patients were followed up 1 year.No extrahepatic bile duct stones were found by B-ultrasonic and MRCP,and bilirubin were normal.Conclusion Laparoscopic transcystic common bile duct exploration has positive clinical efficacy with small trauma,quick rever,less complications,safety and effective.etc.But its indications must be grasped strictly in clinical promotion.