腹腔镜联合胆道镜治疗胆总管结石

目的探讨腹腔镜治疗胆总管结石的合适方法.方法回顾性分析我院2005年5月至2009年7月135例腹腔镜胆总管结石患者临床资料.结果全组均治愈康复,102例手术成功,33例中转开腹手术.102例成功手术患者中,三孔法完成手术13例,四孔法完成手术89例,其中直接经胆总管前壁96例,经胆囊管途径6例.胆总管一期缝合33例,放置"T"管引流63例.其中3例出现一过性胆漏,3～5 d后自愈,2例术后有结石残留,后经"T"管窦道胆道镜成功取出.结论腹腔镜胆总管结石治疗应遵循个体化方案,根据患者病情、医院技术力量、条件不同,采取合适的治疗方式.

Treatment with laparoscopy and choledochoscopy for choledoclolithiasis

Objective To determine the most appropriate method in the treatment of choledocholithiasis. Methods The clinical data of 135 patients who received either laparoscopic common bile duct exploration (LCBDE) or laparoscopic transcystic common bile duct exploration (TC-BDE) from May 2005 to July 2009 were retrospectively studied. Results All patients were cured of choledocholithiasis. In 13 patients three trocars were used, in 89 patients four trocars were used, and in 33 patients conversion to open operation was done. Of the 102 patients in whom minimal invasive surgery was successfully carried out, TC-BDE was done in 6 patients and LCBDE in 96 patients. Primary closure of common bile duct (CBD) was carried out in 33 patients while T-tube drainage was done in 63 patients. Six patients had a transient bile leak which healed spontaneously in 3 to 4 days. Retained stone was detected in 2 patients which was successfully retrieved through choledochoscopy. Conclusion An individualized treatment approach is the most reasonable way to manage CBD stones. The choice of the procedure depends on the number and size of stones, the surgeons experience and the patient's choice.