经腹腔镜治疗复发性胆管结石的临床研究

Laparoscopic treatment of recurring bile duct calculus

目的 探讨腹腔镜在彻底治疗肝内外胆管复发结石的可能性。方法 应用腹腔镜对肝内外胆管复发结石再次手术治疗 ,行胆总管剖开取石 ,置T管引流术。术中及术后胆道镜取石。结果 本组 32例胆管复发结石病人 ,30例应用此方法 ,成功地治疗肝内外胆管复发结石 ;术中并发症 2例 (左侧气胸 1例、十二指肠球部破裂 1例 )经术中处理 ,术后恢复良好 ;2例 (1例因腹腔粘连较重 ,难以游离出有效手术操作空间 ;1例因小肠与腹壁切口大面积粘连 ,在游离过程中小肠破裂及浆膜损伤较重 )中转开腹手术。结论 在熟练掌握腹腔镜技术的基础上 ,应用腹腔镜能完成复发性胆管结石的手术治疗 ,达到微创的目的。

Objective To evaluate the possibility of using laparoscope in treatment of recurring bile duct calculus. Methods Laparoscope was used for re-operation for treatment of recurring bile duct calculus. After the bile duct was cut open and the calculus taken out, a T-shaped glass tube was put into the bile duct and the duct sewed up. During or after the operation, the calculus was taken out with choledochofiberscopy. Results The treatment was successful in 30 patients and there was no complication. For the other 2 with complications, laparotomy was conducted. Conclusions Laparoscope can be used to treat recurring bile duct calculus to achieve the goal of minimal invasion.