胆囊管汇入部微切开技术行腹腔镜胆总管探查取石术267例报告

Micro-incision of the Cystic Duct Confluence Technique in Laparoscopic Choledochal Exploration Lithotomy:Report of 267 Cases

目的总结胆囊管汇入部微切开技术行腹腔镜胆总管探查(laparoscopic common bile duct exploration,LCBDE)的经验。方法2020年1月~2023年3月,对267例胆囊结石胆囊炎合并胆总管结石采用胆囊管汇入部微切开技术行LCBDE,沿胆囊管下壁切开至胆总管汇入部,纵行切开胆总管外侧壁3~5 mm,胆道镜完成胆道探查取石,一期缝合,留置腹腔引流管。结果267例均完成手术,取净胆总管结石。手术时间45~128 min,(96.5±9.7)min;术后腹腔引流管留置时间3~13 d,(5.1±1.2)d;术后住院5~13 d,(6.8±1.1)d。胆漏4例,腹腔引流9~11 d;术后发热11例,抗炎治疗1~3 d;腹腔脓肿形成2例,腹腔引流治愈。242例(90.6%)随访6~39个月,中位时间11个月,其中66例随访≥36个月,结石残留2例,结石复发2例,未发生胆总管狭窄。结论经胆囊管汇入部微切开技术行LCBDE治疗胆总管结石临床效果良好。

Objective To summarize the experience of laparoscopic common bile duct exploration(LCBDE)by means of micro-incision of the cystic duct confluence.Methods From January 2020 to March 2023,267 cases of cholecystolithiasis complicated with choledocholithiasis were given LCBDE by means of micro-incision through the cystic duct confluence.An incision was made along the inferior wall of the cystic duct to the conjunctive part of the common bile duct,and the lateral wall of the common bile duct was cut for 3-5 mm longitudinally.The bile duct exploration and stone extraction were completed under choledochoscope.Primary suture was performed.An abdominal drainage tube was placed.Results The operations were completed in all the 267 cases and the common bile duct stones were thoroughly removed.The operation time was 45-128 min(mean,96.5±9.7 min),the postoperative drainage indwelling time was 3-13 d(mean,5.1±1.2 d),and the postoperative hospitalization time was 5-13 d(mean,6.8±1.1 d).Biliary leakage occurred in 4 cases and was cured after abdominal drainage for 9-11 d.Postoperative fever was noted in 11 cases and was treated with anti-inflammatory therapy for 1-3 d.Abdominal abscess developed in 2 cases and was cured by abdominal drainage.A total of 242 cases(90.6%)were followed up for 6-39 months(median,11 months),of which 66 cases were followed up for more than or equal to 36 months.Residual stones were found in 2 cases,stone recurrence was noted in 2 cases,and no choledochal stenosis was found.Conclusion Laparoscopic lithotomy with micro-incision of the cystic duct confluence has a good clinical effect in the treatment of choledocholithiasis.