腹腔镜下经胆囊管的胆总管探查取石术治疗肝外胆道结石

目的探讨腹腔镜下经胆囊管的胆总管探查取石术治疗肝外胆道结石的临床应用效果。方法应用该方法治疗胆囊结石合并胆总管结石26例，总结其临床资料。结果经胆囊管途径取石成功率为24／26，1例因胆囊管变异，1例导丝插入胆总管未成功，中转为胆总管切开术。术中扩张时无胆管撕裂，术后无腹腔出血、胆漏发生，无围手术期死亡。术后住院时间4-8d.结论对于胆囊结石合并继发性肝外胆管结石的病例，在采用腹腔镜下1次手术的方式治疗时，应首先考虑经胆囊管途径，以争取更小创伤以便更快地恢复。

Laparoscopic transcystic common bile duct exploration for extrahepatic cholelithiasis

[Objective] To evaluate the clinical results of laparoscopic transcystic common bile duct exploration for extrahepatic cholelithiasis. [Methods] Laparoscopic transcystic CBD exploration was performed on 26 patients with cholecystic and CBD calculi. The clinical data were analysed respectively. [Results] Complete CBD stones clearance was achieved in 24 of 26 patients. Two cases were converted to choledochotomy, one due to anatomic anomaly, and another due to failure in introducing the guidewire into the CBD. No bile duct laceration happened during dilation, and no bile leakage or mortality after operation. The duration of post-operation hospital stay was 4 to 8 days. [Conclusions] Laparoscopic transcystic common bile duct exploration was effective for patients with both cholecystic and CBD stones and it was less traumatic than through the choledochotomy pathway. The procedure maybe considered as the first choice in patients with this kind of disease and selecting single session surgery other than ERCP+LC.