开腹器械在36例腹腔镜胆总管切开取石术中的应用

目的探讨腹腔镜胆总管切开取石术(LCBDE)中应用开腹器械取石的可行性。方法回顾性分析我院36例LCBDE取石的临床资料。胆总管切开后以纤维胆道镜检查确定结石的部位、大小及数量,以常规开腹胆道取石器械进行胆道取石,并与同期36例开腹手术进行比较。结果LCBDE组36例手术均获成功,无中转开腹。常规于术后4周行T管造影,34例示结石取净;胆道残余结石2例,均于术后6周经T管窦道胆道镜取石治愈。在手术时间上,LCBDE组与开腹手术组相比无显著性差异(P>0.05);术后住院时间较开腹手术组明显缩短(P<0.05)。两组均留置T管,均无胆瘘、胆管狭窄或出血病例,均痊愈出院。LCBDE组36例随访6~48个月均无异常。结论严格选择手术适应证,应用开腹器械进行腹腔镜胆道取石安全有效、操作容易、成本低、手术时间短。

Application of open bile duct operative instruments in laparoscopic common bile duct exploration

Objective To evaluate the ability of removing stones with open bile duct operative instruments in laparoscopic common bile duct exploration(LCBDE).Methods Clinical features of 36 cases with LCBDE in the hospital were reviewed.Choledochofiberscopic examination was used to confirm the place,size and numbers of stones,and stones were removed by open bile duct operative instruments.Then made a comparison with the result of 36 cases with laparotomy.Results LCBDE in 36 cases were successful,none of them was converted to laparotomy.Four weeks after operation,T tube imaging examination showed:stones were removed completely in 34 cases and there were residual stones in 2 cases.They were removed by biliary tract endoscope through T tube sinus 6 weeks after operation.There was no significant difference in operative time between the two groups(P>0.05),also the time of staying in hospital after operation was less than that of laparotomy group(P<0.05).T tube was placed in both groups,no biliary fistula,bile duct stricture and hemorrhage occurred.6-48 months of followed up was made in LCBDE group and found no abnormal.Conclusions Bases on correct operative indication,remove stones with open bile duct operative instruments in LCBDE has the advantages of safety,efficiency,low cost,short operative time and easy to operate.