双镜联合经胆囊管胆总管探查术的临床应用

Clinical application of laparoscopic combined with choledochoscopic trans-cystic common bile duct exploration

目的:探讨腹腔镜联合胆道镜经胆囊管行胆总管探查的适应证及手术技巧。方法:2016年10月至2017年10月采用双镜联合经胆囊管行胆总管探查术治疗125例胆囊结石合并胆总管结石患者。结果:122例(97.6%)成功完成手术,1例因结石直径较大(约2 cm),2例因急性胆囊炎、胆囊管水肿粘连严重,改行腹腔镜胆总管探查取石术。手术时间60～130 min,平均(80.4±15.7) min;术中出血量5～20 mL,平均(10.4±4.5) mL;术后住院2～7 d,平均(4.3±1.9) d;住院费用12 130.2～21 378.5元,平均(16 542.0±2 375.6)元。术后1例出现结石残留,残石率为0.8%(1/122);并发症发生率为3.3%(4/122)。结论:对于胆囊结石合并胆总管结石,尤其继发性胆总管结石,双镜联合经胆囊管胆总管探查取石疗效良好,严格把握手术指征,此术式可作为可行的治疗方法之一。

Objective ： To explore the indications and surgical techniques of laparoscopic combined with choledochoscopic trans- cystic common bile duct exploration （LTCBDE）.Methods ：The clinical data of 125 patients, who suffered from cholecystolithiasis and choledocholithiasis and underwent LTCBDE from Oct.2016 to Oct.2017,were retrospectively analyzed.Results ：The LTCBDE was suc- cessfully accomplished in 122 patients （97.6%） , and 3 cases was converled to laparoscopic common bile duct exploration ,for the diam- eter of stone was too big （about 2 cm） in one case and acute cholecystitis,edema and adhesion of cystic duct in other two cases.The time of operation was （ 80.4± 15.7） rain （ range ,60-130 rain）, and the intraoperative blood loss was （ 10.4±4.5 ） mL （ range ,5-20 mL）. The length of postoperative hospital stay was （4.3±1.9）d （range,2-7 d）.The total hospitalization charge was （16 542.0±2 375.6） yuan （range, 12 130.2-21 378.5 yuan）.Only one case suffered from residual stones.The percentages of residual stones and complica- tions were 0.8% （1/122） and 3.3% （ 4/122）, respectively. Conclusions ： For cholecystolithiasis combined with choledocholithiasis, es- pecially secondaU choledocholithiasis, LTCBDE is effective, and if the operative indication can be grasped well, this method is one of the feasible treatment.