腹腔镜胆道探查取石术60例临床分析

Clinical experiences of laparoscopic common bile duct exploration (60 cases)

目的探讨腹腔镜胆道探查取石术手术入路及临床疗效。方法收集 6 0例患者的临床资料 ,总结其手术时间、住院时间、手术并发症、手术成功率及残石率 ,4 1例患者获得电话随访。结果 6 0例患者均有胆囊结石 ,其中合并胆总管结石 4 7例 ,胆总管扩张未见结石 8例 ,合并有肝胆管结石 5例。术前患者诊断主要依靠彩色B超和 /或ERCP检查。无黄疸者 11例 ,总胆红素 >10 0 μmol/L者 2 1例 ,总胆红素 2 0～ 10 0 μmol/L者 2 8例。腹腔镜胆囊切除、胆道探查术患者手术时间为 1～ 2 5h。住院时间 5～ 14d。手术入路 :经胆总管者 4 9例 ,经胆囊管者 11例。手术取石情况 :结石数目 >6枚者 8例 ,3～ 6枚者 39例 ,3枚以下者 13例。结石直径为 0 5～ 1 2cm。术后 5例发生胆瘘 ,2例发生腹膜炎 ,胆总管残余结石 2例。 4 1例获得电话随访 ,均恢复良好。结论根据患者的情况选择不同的手术入路 ,腹腔镜胆道探查术治疗胆囊结石合并胆总管结石是安全可行的。

Objective To evaluate operative approach and clinical effects of laparoscopic common bile duct exploration. Methods The clinical data of 60 patients undergoing this procedure were collected, and we sum up operative time,hospital days, operative complications and operative success rates. Results All 60 patients had gall stones,including common bile duct stones in 47 cases,8 with common bile duct dilatation only,5 cases were with concomitant hepatobiliary stones. The preoperative diagnosis depended mainly on B-ultrasonography and/or ERCP. Operative procedures were through common bile duct in 49 cases, and through cystic duct in 11 cases. The operative time was between 1～2.5 h and inhospital days were between 5～14 d. Eight cases were with stone number >6, 39 cases were with 3～6, 13 cases were with the number less than 3. The diameter of stones was 0.5～1.2 cm. Five cases suffered from bile leakage, 2 cases from peritonitis and 2 cases from remnant stones in the common bile duct. Forty-one patients were followed up and doing well. Conclusions Surgical approach is choosen on the basis individually. Laparoscopic common bile duct exploration for gallstone concomittant with choledocholithiasis is safe.