腹腔镜胆囊切除术后胆总管再发结石腹腔镜探查术36例报告

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)后胆总管再发结石行腹腔镜胆总管探查的方法及可行性。方法:回顾分析2008~2012年36例LC术后胆总管再发结石患者行腹腔镜联合胆道镜胆总管探查的临床资料。术前行腹部彩超、上腹部增强CT、MRI、MRCP检查,以了解胆总管内径、走行,结石数量、大小、分布情况。结果:34例手术获得成功,其中19例留置T管引流,15例行胆总管一期缝合。2例因腹腔粘连、解剖不清中转开腹行传统胆总管切开探查加T管引流术。手术时间50~150 min,平均(92.5±21.6)min;术中出血量20~160 ml,平均(45±23.4)ml;住院6~15 d,平均(7.5±2)d。术后6~8周常规T管造影后拔管。无严重并发症发生。结论:选择合适的患者,LC术后胆总管再发结石行腹腔镜联合胆道镜胆总管探查是安全、有效的,可达到微创手术的治疗效果。

Laparoscopic exploration for the recidivation of choledocholithiasis after laparoscopic cholecystectomy：a report of 36 cases

Objective： To discuss the method and the practicability of the laparoscopic exploration for the recidivation of choledocholithiasis after laparoscopic cholecystectomy. Methods： Laparoscopic and choledochoscopic common bile duct exploration was performed for 36 patients who suffering from the recidivation of choledocholithiasis after laparoscopic cholecystectomy from 2008 to 2012.The clinical data of 36 cases were analyzed retrospectively. Abdominal ultrasound examination,abdominal CT,MRI,MRCP were given preoperatively in order to understand the course and the internal diameter of the choledoch,the number,size and distribution of the stones. Results： Thirty-four operations were conducted successfully. 15 patients underwent laparoscopic choledocholithotomy and primary suture of common bile duct,and 19 patients underwent the choledocholithotomy and T-tube drainage. 2 cases were converted to traditional open choledocholithotomy and T-tube drainage because of peritoneal adhesion and confusion of the anatomic structure. The surgery time was 50-150 min,average（ 92. 5 ± 21. 6） min. The bleeding loss was 20-160 ml,average（ 45 ± 23. 4） ml. The hospital stay was 6-15 d,average（ 7. 5 ± 2） d. In postoperative 6-8 weeks T tube radiography was given and the T tubes were removed. No serious complication occurred. Conclusions： Laparoscopy combined with choledochoscopic common bile duct exploration for the recidivation of choledocholithiasis after laparoscopic cholecystectomy is safe and effective on the basis of selecting suitable patients,and it can achieve the effect of minimally invasive surgery.