经胆囊管胆道镜胆道探查技术探讨

经胆囊管入路行术中胆道镜胆道探查及治疗具有保持胆总管完整性的优点。我院 1995年 3月至2 0 0 1年 12月成功进行经胆囊管入路探查胆道及取石手术 4 6例 ,现报道如下。材料和方法本组选择的病例为我院 1995年 3月～ 2 0 0 1年12月诊治的 15 2例胆道疾病患者 ,术中试行经胆囊管胆道镜探查胆道 ,成功 4 6例 ,失败 10 6例。成功的病例中男 17例 ,女 2 9例 ;年龄 34～ 82岁 ,中位年龄 67岁。我们使用的胆道镜型号为Ｏｌｙｍ ｐｕｓＴ2 0Ｑ。方法 :术中切除胆囊后 ,充分游离胆囊管 ,残留长度至少在 0 .3～ 0 .5ｃｍ ,胆囊管口径在 0 .3～ 0 .4ｃ…     

腹腔镜联合胆道镜经胆囊管胆道探查日间手术可行性探讨

目的探讨腹腔镜术中联合胆道镜经胆囊管胆道探查(laparoscopic transcystic common bill duct exploration,LTCBDE)并取石术实施日间手术的可行性。方法回顾性分析2016年2月至2017年5月在首都医科大学附属北京友谊医院由同一组手术团队完成的39例择期行LTCBDE治疗胆囊结石合并胆总管结石的临床资料。所有患者均在门诊完成术前检查和术前评估;患者于手术当日入院,术后24 h内离院回家;回家12h内电话随访,术后第7日门诊随访。结果 39例患者均顺利完成LTCBDE,无胆总管切开及中转开腹,术后所有患者均于入院24 h内出院,其中手术当天出院37例,过夜观察次日晨出院2例。手术时间45~113 min,平均手术时间(72.5±24.8)min;39例患者术后6 h均进流食,术后腹部切口疼痛23例,恶心、呕吐12例,伤口少量渗血2例,给予常规对症处理后缓解。住院费用平均(9 134.6±824.4)元。随访至今无腹部不适症状。结论严格掌握适应证,选择性施行LTCBDE的日间手术是安全可行的,适合有条件的大型医院开展。     

经胆囊管胆道镜胆道探查、排石取石

传统方式治疗胆道结石多采用胆总管切开方式，而忽略了胆囊管这一天然管道的存在。我们通过临床观察发现经胆囊管治疗胆道结石是完全可行的，也相信这将是胆道外科发展的一个新方向。     

胆囊管扩张术在腹腔镜联合胆道镜胆道探查中的应用

目的 探讨胆囊管扩张术在腹腔镜联合胆道镜胆道探查中的应用.方法 70例胆囊结石合并胆总管继发结石患者在行腹腔镜胆囊切除的同时经胆囊管行胆总管探查术,术中39例采用球囊扩张器和专用胆囊管扩张器行胆囊管扩张术.对照组为31例胆囊管已经有明显扩张未行胆囊管扩张术的患者.结果 胆囊管扩张组39例中,术后1例胆漏,1例胆囊管撕裂,经保守处理痊愈.非胆囊管扩张组1例术后动脉夹脱落出血行腹腔镜探查治愈,未出现胆漏.扩张组术后3 d平均腹腔引流为(60±11)mL,非扩张组为(55±8)mL,两组比较无显著性差异(P>0.05).两组术后随访病例3个月复查B超未发现胆道残余结石.结论 胆囊管扩张术是建立经胆囊管腹腔镜胆道探查术胆道镜通道的简单安全的方法,为部分胆总管继发结石治疗提供良好的通道.     

腹腔镜经胆囊管胆道探查术手术技巧的探讨

目的探讨经胆囊管途径行腹腔镜胆道探查取石术的手术操作技巧。方法总结2003年12月至2012年12月开展的897例腹腔镜经胆囊管胆总管探查术的手术经验,分析手术适应证、手术操作步骤及要领。结果841例顺利完成腹腔镜经胆囊管胆总管探查术,56例改行腹腔镜胆总管切开探查术、T管引流术。行腹腔镜经胆囊管胆总管探查术组的平均手术时间为（98．1±38．1）min,术后住院天数为（3．5±1．9）d,胆漏4例,无其他严重并发症;平均随访时间18．6个月（3～36个月）,无胆道狭窄发生。结论切开胆囊管胆总管汇合部、适度扩张切口加上熟练的胆道镜操作技术是完成腹腔镜经胆囊管胆总管探查取石术的关键所在。     

经胆囊管胆道镜探查治疗继发性胆总管结石

近年来广泛开展腹腔镜或小切口胆囊切除术,极易忽略继发性胆总管结石,胆囊结石继发性胆管结石的发生率为6%～19.5% [1],因此应予以高度重视[2].     

经胆囊管行术中胆道镜胆道探查87例分析

目的探讨经胆囊管行术中胆道镜胆道探壹的临床应用价值。方法对1997年9月至2004年12月82例开腹胆囊切除术病人经胆囊管行术中胆道镜胆道探壹术，5例腹腔镜下经胆囊管行胆道镜胆道探查术资料进行回顾性分析。结果病人结石清除率为100％。术后平均住院7．2d。结论在无禁忌证的前提下，无论是开腹还是腹腔镜手术。应首先考虑经胆囊管途径行胆道镜胆道探查取石术。     

超细胆道镜在术中经胆囊管胆道探查的临床应用

目的探索胆道探查手术中应用超细胆道镜的临床价值。方法开腹或腹腔镜手术切除胆囊后保留残留胆囊管0．5～0．6cm,经胆道探条或血管分离钳机械扩张胆囊管,直至CHF—XP20超细纤维胆道镜随意插进胆总管,观察胆总管、肝总管及左右肝管,同时可以经胆道镜活检孔道插入配置的取石网篮取石,或插入配置的活检钳进行组织活检。结果332例胆总管内小结石（0．3～0．5cm）,其中25例合并肝内一级胆管结石,术中经超细纤维胆道镜检查证实后,使用网篮顺利取出;9例胆总管内隆起样病变取组织活检,其中炎性息肉样病变5例,轻一中度不典型增生病变4例;胆总管下端炎性狭窄及乳头肌收缩功能减退24例。365例经胆囊管进行均顺利完成超细纤维胆道镜检查及治疗,术中未出现胆道持续出血、胆道穿孔及术后胆道感染等并发症。295例随访3～12个月（平均7．5月）,未发现术后残余结石,继续随访13～18个月（平均15．5月）,胆总管结石复发12例。结论超细纤维胆道镜经胆囊管进行胆道探查手术有严格适应征,合理、选择性的应用可避免总胆管切开。     

腹腔镜下胆道镜经胆囊管胆总管探查取石技术应用现状

腹腔镜下经胆囊管胆总管探查术(laparoscopic trans-cystic common bill duct exploration,LTCBDE)主要应用于一些胆囊结石合并胆总管结石的病人,在行腹腔镜切除胆囊后,利用胆道镜通过胆囊管这一"废弃"的自然通路完成胆总管的探查取石.     

经胆囊管探查减压在肝囊型包虫手术中的应用

目的 探讨经胆囊管探查减压在肝囊型包虫手术中处理隐匿型胆漏的疗效.方法 回顾性分析新疆医科大学第一附属医院从2002年6月到2008年6月手术治疗的819例肝囊型包虫病人中实施胆道探查的172例资料,对术后平均住院日、术后残腔并发症(胆漏、残腔积液、残腔感染)、胆道并发症(胆道梗阻、胆道狭窄、胆道感染、胆漏)进行比较分析.结果 经胆囊管探查减压组(A组)术后残腔并发症、术后平均住院日与胆总管探查"T"管减压组(B组)无明显差异,但胆道并发症两组具有统计学意义(P<0.05).结论 经胆囊管探查减压在肝囊型包虫手术中具有操作简单、安全、有效,术后彻底解决残腔胆漏,并可避免传统T管减压相关并发症等优点.     

Operative common bile duct imaging by operative cholangiography and flexible choledochoscopy.

A consecutive series of 108 common bile duct (CBD) explorations was studied to examine the efficacy of routine operative cholangiography and flexible choledochoscopy in the identification of choledocholithiasis. CBD exploration was performed according to the findings of routine operative cholangiography. Nine negative explorations were performed, only one of which would have been avoided had selective cholangiography been employed. Eight patients had unsuspected choledocholithiasis that would have been missed if selective operative cholangiography had been used. Flexible choledochoscopy identified CBD stones on 97 occasions; no additional retained stones were found on subsequent T tube cholangiography. In two cases stones were seen but could not be removed; immediate identification allowed planning for early removal. Flexible choledochoscopy is the most effective method of CBD exploration and should be used in all patients with suspected choledocholithiasis.     

Laparoscopic C-tube drainage via cystic duct following common bile duct exploration

Laparoscopic common bile duct (CBD) exploration has come into practice with the development of laparoscopic techniques and instrumentation. However, the use of a T-tube for biliary drainage lessens the advantages of laparoscopic surgery, i.e., short hospital stay and good cosmesis. We have performed CBD exploration by laparoscopic chledochotomy followed by transcystic biliary drainage using a 6 French vinyl tube (C-tube) instead of a T-tube and primary closure of the choledochotomy. The C-tube could be removed within 7 days postoperatively because the cystic duct was ligated with an elastic thread. Twelve patients with CBD stones were successfully treated by this new technique and there was no morbidity attributable to the procedure.     

Laparoscopic common bile duct stone clearance with flexible choledochoscopy

Background Laparoscopic common bile duct exploration (LCBDE) is as safe and efficient as endoscopic retrograde cholangiopancreatography (ERCP) in achieving bile duct clearance from stones. No clear guidelines are available on LCBDE with respect to indications for trans-cystic approach versus choledochotomy, or regarding when to use either flexible choledochoscopy (FCD) or intraoperative cholangiography (IOC) guidance. Methods From January 2001 until November 2006, 113 consecutive patients with common bile duct stones (CBDS) and gallbladder in situ were enrolled in a prospective non-randomized study to undergo laparoscopic cholecystectomy with LCBDE on an intention-to-treat basis. Twenty-three patients were aged 80 years or older with severe comorbidity. Preoperative ERCP with attempted stone clearance was performed in 24 patients. Laparoscopic common bile duct exploration was attempted for CBDS in the presence of acute cholecystitis in 24 patients. Laparoscopic common bile duct exploration was performed via the trans-cystic approach in 83 patients and via choledochotomy in 30 patients. Flexible choledochoscopy was used in 79 patients and IOC guidance in 34 patients. Results No mortality occurred. Postoperative complications were encountered in nine patients. Laparoscopic stone clearance of the bile duct was successful in 91.8% of the patients. Median length of hospital stay (LOS) was two days (range, 0 to 24 days) after trans-cystic LCBDE and six days (range, 2 to 34 days) after stone clearance via choledochotomy (p < 0.0001). Choledochotomy was performed for CBDS measuring an average of 11.5 mm (range, 5 to 30 mm) in diameter while trans-cystic LCBDE was successful for stones measuring an average of 5 mm (range, 2 to 14 mm) (p < 0.0001). Mean duration of surgery was 75 minutes (range, 30 to 180 minutes) when FCD was used, and 107 minutes (range, 45 to 240 minutes) in patients undergoing LCBDE under IOC guidance (p < 0.0001). Conclusion Laparoscopic cholecystectomy and LCBDE with stone extraction can be performed with high efficiency, minimal morbidity and without mortality. A trans-cystic approach is feasible in most patients, whereas choledochotomy should be restricted to large bile duct stones that cannot be extracted through the cystic duct. The use of flexible choledochoscopy is preferable to IOC guidance.     

腹腔镜下经胆囊管胆总管汇合处切开治疗胆总管结石

目的探讨腹腔镜经胆囊管胆总管汇合处切开治疗胆总管并发结石的可行性。方法对187例患者,术中应用CB30L超细胆道镜确诊183例,胆道造影确诊4例,均再经胆囊管胆总管汇合处切开胆总管侧壁,应用P20胆道镜实施胆管探查取石术。结果经汇合处切开胆总管侧壁成功取出结石179例（95.7%）,改行切开胆总管前壁取石8例（4.3%）。一期直接缝合85例,其中胆漏11例,均一周内愈合。放置胆囊管导管74例,胆漏6例,3-5d停止。放置T形管20例,胆漏2例,3d停止。改行前壁取石的患者成功5例,中转开腹3例。术后残留结石3例,经内镜十二指肠乳头括约肌切开取石2例,经T形管窦道取石1例。随访185例患者,时间3个月-3年,未见胆管狭窄。结论采用经胆囊管胆总管汇合处切开入路治疗胆总管并发结石,创伤小,恢复快。     

腹腔镜胆总管探查术中细纤维胆道镜的应用

4例胆囊结石的病人在行腹腔镜胆囊切除术中行胆道造影并经细纤维胆道镜经胆囊管扩取石。2例经造影证实为胆总管下端结石,1例取石成功,另1例因结石较大而致使取石失败,后经内镜乳头括约肌切开取石成功。1例造影怀疑胆总管下端结石,术中镜检正常。1例切开胆囊管冲洗泥沙样结石并取石成功。LC术中采用细纤维胆道镜检查并取石是一安全有效的手段。     

腹腔镜联合胆道镜胆总管探查并一期缝合的临床研究

探讨腹腔镜联合胆道镜胆总管探查后进行一期缝合的安全性及临床意义.回顾性分析2013年1月至2018年1月在我院普通外科行腹腔镜胆总管探查手术的患者,按照胆总管的处理方式分为两组,其中一期缝合组(观察组)121例,T管引流组(对照组)153例,观察两组患者在围手术期手术安全性等观察指标间的差异.两组共274例患者均在腹腔...     

腹腔镜胆总管探查一期缝合41例报告

目的 探讨腹腔镜胆总管切开检查免置T管的可行性及病例选择.方法 选择性地对41例有胆总管探查指征的病人在术中行腹腔镜、胆道镜双镜联合胆总管切开取石后行胆总管一期缝合,回顾性分析其手术的可行性.结果 本组41例全部治愈出院,引流管1～2d拔出.术后发生胆漏1例,术后5d拔出引流管.无胆道狭窄及腹腔感染病例.结论 若术者腹腔镜、胆道镜技术熟练,手术病例选择适当,术中检查仔细,冲洗干净,一期缝合是安全可行的.     

Operative choledochoscopy: common bile duct exploration is incomplete without it

This paper reviews the reported experience of operative choledochoscopy. Development of choledochoscopes to the currently available rigid and flexible instruments is described. The collected results of both rigid and flexible choledochoscopy are reported. Retained stones occurred in 97 of 2712 stone-positive explorations with the rigid choledochoscope (3.6 per cent) and in 35 of 1726 stone-positive explorations with the flexible choledochoscope (2.0 per cent). Choledochoscopy should now be a mandatory part of common bile duct exploration.     

免胆道镜腹腔镜胆总管探查术82例经验

免胆道镜腹腔镜胆总管探查术指的是在腹腔镜胆总管探查术中不使用胆道镜技术,而用常规开腹手术器械进行探查、取石.我们在此方面做了一些尝试,取得了一定经验,现报告如下.