腹腔镜胆囊切除术中胆囊管结石的处理

目的探讨LC中胆囊管结石的诊断、手术方法及术后并发症的预防。方法该组216例胆囊管结石行LC，在结石远段胆囊管上钛夹，将结石推入胆囊内或直接切开胆囊管取石，行术中胆道造影37例，胆道镜检查取石14例，放置T管51例，放置腹腔引流管142例。结果所有病例均顺利完成手术。无中转开腹，无胆漏；2—4d后拔除腹腔引流管，2—6周拔除T管。3例分别于术后1，3和10d出现腹痛，B超发现结石掉入胆总管，行EST取出结石。结论胆囊管结石在LC术中越来越多见，正确诊断选择适当的处理方法，必要时行术中胆道造影及胆道镜检查是提高手术成功率的关键。

Management 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: 216 cases of LC were reviewed, in which the distal cystic duct to stone was clamped by titan clips, the stones were pushed into gallbladder or taken out directly by cutting open the cystic duct. 37 of 216 cases undertook intraoperative cholangiography. 14 cases were performed with choledochoscopic way. T-tubes were detained in 51cases. Abdominal cavity drainage-tubes, 142 cases. Results: All cases were completed successfully. No case converted to open operation. No bile leakage. Abdominal cavity drainages-tubes were discharged (2~4) days post operation; T-tubes, (0.5~1.0) month. Abdominal pain presented in three patients at the first, third and 10th day respectively, which proved common bile duct stone that came from gallbladder. Finally, these three patients undertook EST successfully. Conclusions: Appropriate management of calculus of cystic duct as well as cholangiographc and choledochoscopioc ways at certain conditions, abdominal drainag and postoperative anatomy of gallbladder is important for LC.