腹腔镜联合胆道镜行胆道再手术治疗肝外胆管结石的临床疗效

目的探讨腹腔镜联合胆道镜行胆道再手术治疗肝外胆管结石的疗效。方法回顾性分析2009年9月至2011年12月第三军医大学西南医院收治的41例肝外胆管结石患者的临床资料，其中单纯胆总管多发结石30例，胆总管结石合并残余胆囊及胆囊管结石11例；1次手术史者23例，2～3次手术史者18例。采用腹腔镜联合胆道镜进行再次手术取石。采用电话方式进行随访，随访时间截至2012年6月。结果39例患者成功完成腹腔镜联合胆道镜行胆道再手术，手术成功率为95．1％（39／41）。2例患者因胆管狭窄及肝门部致密粘连中转开腹手术。术中出血量为（33±10）mL，手术时间为（150±39）min，术后胃肠功能平均恢复时间为2d，术后住院时间为（6．5±2．5）d。患者术后无严重并发症发生，全部痊愈出院。39例患者平均随访时间为7个月（2～27个月），无结石残留及复发，无胆管狭窄。结论腹腔镜联合胆道镜行胆道再手术治疗肝外胆管结石安全有效，具有创伤小、恢复快及并发症少的优点。

Clinical efficacy of reoperation by laparoscopy and choledochoscopy for the treatment of extrahepatic bileduct stones

Objective To investigate the efficacy of reoperation by laparoscopy and choledochoscopy for the treatment of extrahepatic bile duct stones. Methods The clinical data of 41 patients with extrahepatic bile duct stones who were admitted to the Southwest Hospital of Third Military Medical University from September 2009 to December 2011 were retrospectively analyzed. Of the 41 patients, 30 were with multiple choledocholithiasis, 11 were with choledocholithiasis combined with retained calculus of the gall bladder and cystic duct. Twenty-three patients received previous upper abdominal surgery for once, and 18 patients for twice or thrice. All patients underwent reoperation by laparoscopy and choledochoscopy. Patients were followed up via phone call till June 2012. Results Reoperation by laparoscopy and choledochoscopy was successfully done on 39 patients, with the success rate of 95.1% （39/41）. Two patients were converted to open surgery due to cholangiostenosis or adhe- sion. The mean volume of blood loss was （33 _＋ 10） mL, and the mean operation time was （150 -＋ 39）minutes. The mean time for gastrointestinal function recovery was 2 days, and the postoperative hospital stay was （ 6.5 ＋ 2.5 ）days. All patients were cured without severe complications. All patients were followed up for 7 months （range, 2-27 months） , and no residual bile duct stones or recurrence were found. Conclusion Reoperation by laparoscopy and choledochoscopy for the treatment of extrahepatic bile duct stones is effective with advanteges of minimal trauma, quick recovery and fewer complications.