腹腔镜胆囊切除术中如何避免胆囊管结石残留的体会

目的探讨LC术中胆囊管结石的诊断、处理方法及术后并发症的预防。方法回顾性分析我院1999年6月～2006年12月间行LC的1522例中合并胆囊管结石81例的临床资料。结果本组除1例中转开腹外,余者均顺利完成手术。本组术后未发生胆漏。术后2～4d后拔除腹腔引流管,2～6周后拔除T管。随访2月～2年,病人恢复满意。结论胆囊管结石在LC术中越来越多见,术前和术中处理是重要的预防措施,挤压法是基本处理方法。必要时,行术中胆道镜和胆道造影检查能提高手术成功率。

Treatment and prevention of calculus of cystic duct during laparoscopic cholecystectomy

Objective To explore the diagnosis and operative methods of calculus of cystic duct during laparoscopic cholectystectomy(LC)and prevention of post-LC complications.Methods 1 522 cases of LC in our hospital between June 1999 and December 2006 were reviewed,in which 81 cases were found having calculus of cystic duct.Results All cases were operated on successfully except that one case was converted to open operation.No bile leakage after operation occurred.Abdominal cavity drainage tubes were discharged 2-4 days after operation and T-tubes extracted 2-6 weeks later.The curative effects were satisfactory during a follow-up of 2 months to 2 years.Conclusion The treatment before and during LC operation is important to prevent calculus of cystic duct.Extrusion is the basic operative method.Cholangiography and choledochoscopy during operation can increase the successful rate of LC operation.