腹腔镜联合术中胆道镜治疗胆总管结石186例分析

目的探讨腹腔镜联合胆道镜在治疗胆囊结石合并胆总管结石术中的应用体会和常见并发症及其防治措施。方法回顾分析186例腹腔镜下胆道镜胆总管探查取石术患者临床资料,180例腹腔镜下完成手术,其中98例放置T管,57例Ⅰ期胆总管缝合,25例经胆囊管取石;6例术中中转开腹。结果术后胆漏2例,经引流痊愈;5例胆总管残余结石,术后行ERCP或经T管窦道胆道镜取石;平均住院时间(6.0±3.5)d。带T管的98例患者术后4周经T管胆道造影未见结石残留,胆道通畅,拔除T管。结论腹腔镜联合胆道镜在胆总管切开取石术中的应用具有疗效好、并发症少、安全的优点。

Laparoscopic and Intraoperative Choledochoscopic Common Bile Duct Exploration for Patients of Choledocholithiasis (186 Cases Report)

Objective To discuss the operative experiences,common complications and preventions of the treatment of laparoscope and intraoperative choledochoscope for the patients of cholecystolithiasis combined with choledocholithiasis.Methods Retrospective analysis was applied in 186 patients underwent the laparoscopic and choledochoscopic common bile duct exploration.There were 180 cases successfully completed the laparoscope,and the other 6 cases were transferred to laparotomy during the laparoscopic procedure.In the 180 cases underwent LC,T tubules were left in 98 cases,57 patients＇ common bile ducts were sutured after exploration,and the other 25 cases were treated by transcystic common bile duct exploration.Results Postoperative bile leakages were found in 2 cases and were cured by drainage.Five cases of residual common bile duct stones were cured by the postoperative ERCP or trans-T tube cholangioscopy 4 weeks after operaion.The average hospital stay was（6.0±3.5） days.Conclusion Laparoscopic and choledochoscopic common bile duct exploration is of good efficacy,few complications and safe treatment for the patients of cholecystolithiasis combined with choledocholithiasis.