腹腔镜胆囊切除术后残株胆囊及胆囊管结石

目的探讨腹腔镜胆囊切除术后残株胆囊／胆囊管结石的原因、诊断、处理及预防方法。方法回顾总结我院 1992-2005年间收治的8例腹腔镜胆囊切除术后残株胆囊／胆囊管结石病例的临床资料。结果 8例病人术前经B超、MRI、 ERCP检查确诊后,均经再次手术治愈。残株胆囊结石2例;残株胆囊管结石6例,其中2例合并胆总管结石;2例行残余胆囊切除术,6例行残株胆囊管切除、其中4例附加胆总管切开探查和／或取石、T型管引流。随访1．1-13年,效果良好。结论判断失误是腹腔镜胆囊切除术后残株胆囊结石的主要原因,过长的炎性及畸形的胆囊管残留是腹腔镜胆囊切除术后残株胆囊管结石的主要原因;其症状和体征类似于结石性胆囊炎、合并胆管结石时可有黄疸;B超、CT、ERCP等检查可确诊;再次手术切除(或取出)残株胆囊／胆囊管(结石)是有效可靠的治疗方法;娴熟的腹腔镜技术、术中胆道造影、正确掌握中转开腹指征以及丰富的胆道外科经验是预防其发生的关键。     

胆囊管残株结石诊治体会

胆囊切除术是治疗结石性胆囊炎最常见的外科手术。如术中未将胆囊管完整切除或胆囊管残留有结石均可导致胆囊管残株结石,常需再次手术[1]。我院1988年1月至2002年6月间共收治该类患者17例,均行手术治疗,现报告如下。1临床资料1.1一般资料本组17例,其中男8例,女9例;年龄28~69岁,     

腹腔镜胆囊切除术中胆囊管结石的处理体会

腹腔镜胆囊切除术（LC）中胆囊管结石的发生率逐年上升,且为手术困难原因之一,处理不当易导致胆瘘、胆道狭窄、黄疸及胰腺炎等术后并发症。我院2005年5月—2010年6月共完成LC手术827例,其中合并胆囊管结石63例,总结报道如下。     

腹腔镜胆囊切除术中胆囊管结石的处理

目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中胆囊管残株结石的预防方法。方法 2006年8月~2009年8月LC术中对25例胆囊管结石采用全面显露胆囊管并对其进行刮推、钳夹、切开、冲洗、造影等方法取石。结果 1例术后发现胆囊管残端有黄染,放腹腔引流2d后拔管;1例造影时发现在汇合部有一结石残渣用水冲出。无结石挤入胆总管病例。25例胆囊管结石全部取净。25例随访6~36个月,平均27.4月,未发现胆囊管株残结石的发生。结论对胆囊管认真解剖和探查,恰当的操作可有效预防胆囊管残株结石的发生。     

腹腔镜下胆囊管结石治疗体会

目的 探讨腹腔镜下胆囊管结石的诊断及处理. 方法 回顾性分析本院2005年3月至2012年6月经腹腔镜胆囊切除术(LC)治疗的25例胴囊管结石病人的临床资料和手术过程. 结果 全组均行手术治疗.术中全程解剖胆囊管,腹腔镜下利用推挤法和切开取石法22例;2例术中转开腹;1例患者部分结石落入胆总管,术后经内镜下乳头括约肌切开术(EST)取石痊愈;1例术后出现胆漏,通畅引流8天后痊愈.所有患者随访0.5～7年,未发现胆管狭窄及残余结石. 结论 腹腔镜处理胆囊管结石是安全可行的.胆囊切除中谨慎处理胆囊管防止结石遗漏,灵活运用腹腔镜技术是手术成功的关键.     

腹腔镜胆囊切除术及保胆取石术处理胆囊管结石的体会

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)及保胆取石术中胆囊管结石的诊断与处理方法,以指导选择正确的手术方式,预防术后并发症的发生.方法:回顾分析2005年3月至2011年3月为1 326胆囊结石患者行LC (LC组)及118例患者行保胆取石术(保胆取石组)的临床资料....     

腹腔镜胆囊管汇入处T形切开治疗胆总管结石的体会

目的:探讨腹腔镜胆囊管汇入处T形切开治疗胆总管结石的应用价值及技术要点。方法:回顾分析2014年2月至2016年2月为22例胆囊结石合并胆总管结石患者行腹腔镜胆囊管汇入处T形切开的临床资料,其中男10例,女12例;20~79岁,平均(58.2±3.8)岁。3例有腹部手术史。胆总管直径6~20 mm,平均(11.5±4.9)mm。结果:22例手术均获成功,结石均取净。胆总管结石数量1~5枚,结石直径5~20 mm,平均(9.8±4.4)mm。手术时间平均(83±18)min,术后平均住院(8.2±2.1)d。患者顺利恢复,无死亡病例及并发症发生。中位随访8.5个月,无胆管损伤、狭窄、结石复发病例。结论:在严格筛选病例、掌握各项操作注意事项的前提下,腹腔镜胆囊管汇入处T形切开治疗胆总管结石安全、有效,具有一定的临床应用价值。     

腹腔镜胆囊切除术后胆囊管结石残留的预防及处理

目的 探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）术后胆囊管结石残留的预防及处理.方法 回顾性分析自2004年5月至2012年12月间共成功施行4 751例LC的临床资料.结果 135例LC术中采用胆囊管远端紧靠壶腹部施夹钛夹、切开胆囊管、自近端向远端挤压法取出胆囊管结石;其余4 616例中,12例术后发生胆囊管结石残留,4例经再次腹腔镜手术、8例经开腹手术成功取石,未再发生结石残留及其他严重并发症.结论 对胆囊管残余结石高风险病例,LC术中采用切开胆囊管、自近端向远端挤压法是预防术后胆囊管结石残留的有效方法.确诊LC术后胆囊管结石残留,应积极手术治疗,选择合适的病例再次经腹腔镜手术取出结石是安全可行的.     

合并胆囊管结石的腹腔镜胆囊切除术

目的探讨胆囊管结石的腹腔镜处理方法及手术技巧。方法对巢湖市第二人民医院普外二科2006～2011年收治的52例胆囊管结石患者临床资料加以总结分析。结果本组资料中,采用挤压法处理35例,胆囊管切开取石+钛夹闭合处理10例,胆囊管切开取石+胆囊管残端缝合5例,中转开腹二例;本组无手术并发症,随访1～2年,无胆囊管残留结石,胆管损伤、胆总管继发结石等并发症发生。结论掌握正确的术中处理方法及良好的手术技巧,绝大多数胆囊管结石可以通过腹腔镜成功完成手术,效果满意。     

腹腔镜联合胆道镜治疗胆囊结石伴胆囊管结石

目的:探讨腹腔镜联合胆道镜治疗胆囊结石合并胆囊管结石的手术方法及临床经验。方法:回顾分析2018年5月至2021年3月收治的17例胆囊结石合并胆囊管结石患者的临床资料,分析腹腔镜联合胆道镜手术的方法、术中难点及处理经验。结果:本组17例手术均顺利完成,无中转开腹及胆管损伤发生,术后患者均顺利康复。14例(82.4%)采用常规三孔法、3例(17.6%)采用四孔法施术。处理胆囊三角：常规入路14例(82.4%),壶腹入路3例(17.6%)。处理胆囊管结石：以腔外游离为主,腔内探查为辅,纵行切开取石。患者均完成腹腔镜联合胆道镜探查胆囊管并取石,其中1例(5.9%)行胆道镜下网篮取石。处理胆囊管残端：常规夹闭12例(70.6%),线扎2例(11.8%),缝扎1例(5.9%),2例(11.8%)于胆囊管汇入部微切开取石后用6-0可吸收线缝合切开部,再以Hem-o-lok夹闭残端。本组完整切除胆囊8例(47.1%),部分切除9例(52.9%)。9例(52.9%)放置腹腔引流管,72 h后拔除。结论:腹腔镜联合胆道镜治疗胆囊结石合并胆囊管结石安全、有效,术中根据患者情况采取相应处理可保障手术的安全。     

腹腔镜经胆囊管胆总管探查术的临床应用

目的:总结腹腔镜经胆囊管胆总管探查取石术的临床应用经验,探讨手术方法、临床应用的优缺点。方法:应用腹腔镜经胆囊管胆总管探查取石术诊治49例胆道结石患者,回顾分析其临床资料。结果: 49例患者中, 47例获得成功, 1例胆道肿瘤及1例合并左肝管狭窄患者中转开腹,无死亡病例。结论:腹腔镜经胆囊管胆总管探查术是一种创伤小、康复快,安全,并发症少的外科手术方法。     

腹腔镜结合纤维胆道镜经胆囊管行胆总管探查取石6例的体会

目的 :探讨腹腔镜结合纤维胆道镜经胆囊管行胆总管探查取石的可行性、临床价值和手术适应证。方法 :应用腹腔镜手术设备和纤维胆道镜及配套器械为 6例胆总管结石患者实施经胆囊管纤维胆道镜胆总管探查取石术。结果 :手术均获成功 ,手术时间 4 5～ 10 0min ,术后次日下床活动、进食 ,术后 3～ 5d出院。结论 :选择性地实施腹腔镜结合纤维胆道镜经胆囊管行胆总管探查取石临床可行 ,优点明显     

腹腔镜联合胆总管探查术治疗胆囊并胆总管结石

目的探讨腹腔镜下胆囊切除联合胆总管探查取石一期缝合术治疗胆囊结石合并胆总管结石的疗效和安全性。方法回顾性分析2010年2月至2014年12月收治的74例胆囊结石合并胆总管结石患者的临床资料,分别采用腹腔镜下胆囊切除联合胆总管探查取石一期缝合术(观察组37例)和腹腔镜下胆囊切除,胆总管切开取石T管引流术(对照组37例),数据采用SPSS19.0软件处理,术后胃肠道功能恢复情况、电解质和肝肾功能比较以均数±标准差表示,采用t检验;术后并发症发生率采用χ~2检验,P0.05为差异有统计学意义。结果观察组并发症发生率为2.7%低于对照组为8.1%,差异有统计学意义(χ~2=9.83,P0.05);观察组血清Na+,K+水平分别为(145.8±3.2)mmol/L和(4.8±0.5)mmol/L,均高于对照组,其差异均有统计学意义(P0.05);观察组患者的首次排气时间为(1.2±0.4)d,肠鸣音恢复时间为(1.3±0.4)d,对照组患者的首次排气时间为(2.2±0.8)d,肠鸣音恢复时间为(1.8±0.5)d,差异均有统计学意义(t=2.81、2.89,P=0.010、0.006)。结论腔镜下胆囊切除联合胆总管探查取石一期缝合术可干净彻底地清除结石,同时降低术后胆漏、电解质紊乱,消化功能不良等并发症,具有较好的临床疗效和安全性。     

The role of ERCP in laparoscopic cholecystectomy-related cystic duct stump leaks

Background: Laparoscopic cholecystectomy has resulted in an increase in the incidence of cystic duct stump leaks. To assess the role of endoscopic retrograde cholangiopancreatography (ERCP) a review of 14 cystic duct stump leaks following laparoscopic cholecystectomy was carried out. Methods: A retrospective chart review of fourteen patients was carried out. There were 11 females and 3 males. Laparoscopic cholecystectomy was carried out without any difficulty. Three patients became very ill soon after surgery while 11 patients were minimally ill. All were still hospitalized after the cholecystectomy. Results: Urgent ERCP on the 3 very ill patients demonstrated a cystic duct bile leak. In the 11 minimally ill patients, ultrasonography demonstrated intraabdominal fluid collections and initial treatment was percutaneous drainage. Only 2 of the 11 patients improved. The remaining nine patients developed a septic course. ERCP was carried out and demonstrated cystic duct bile leak in all 9 patients. Endoscopic papillotomy alone or endoscopic papillotomy plus stenting resolved the clinical picture. Conclusions: Patients who are ill post laparoscopic cholecystectomy should have urgent ERCP. Cystic duct bile leaks should be managed by endoscopic papillotomy and in select cases, stenting.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Orlando, Florida, USA, 11–14 March 1995     

腹腔镜胆道探查取石术60例临床分析

目的探讨腹腔镜胆道探查取石术手术入路及临床疗效。方法收集 6 0例患者的临床资料 ,总结其手术时间、住院时间、手术并发症、手术成功率及残石率 ,4 1例患者获得电话随访。结果 6 0例患者均有胆囊结石 ,其中合并胆总管结石 4 7例 ,胆总管扩张未见结石 8例 ,合并有肝胆管结石 5例。术前患者诊断主要依靠彩色B超和 /或ERCP检查。无黄疸者 11例 ,总胆红素 >10 0 μmol/L者 2 1例 ,总胆红素 2 0～ 10 0 μmol/L者 2 8例。腹腔镜胆囊切除、胆道探查术患者手术时间为 1～ 2 5h。住院时间 5～ 14d。手术入路 :经胆总管者 4 9例 ,经胆囊管者 11例。手术取石情况 :结石数目 >6枚者 8例 ,3～ 6枚者 39例 ,3枚以下者 13例。结石直径为 0 5～ 1 2cm。术后 5例发生胆瘘 ,2例发生腹膜炎 ,胆总管残余结石 2例。 4 1例获得电话随访 ,均恢复良好。结论根据患者的情况选择不同的手术入路 ,腹腔镜胆道探查术治疗胆囊结石合并胆总管结石是安全可行的。     

两镜联合下胆囊管入路胆总管探查取石的体会

目的:探讨腹腔镜联合胆道镜经胆囊管行胆总管探查取石的手术方法、临床效果及手术体会。方法:回顾分析2011年1月至2013年1月为45例患者行两镜联合胆总管探查取石术的临床资料,根据术前影像学检查分为两组,其中胆囊管入路组13例(A组),胆总管入路组32例(B组),对比分析两组手术时间、术中出血量、探查阴性率、T管留置率、住院时间、术后残石率等指标。结果:两组均无中转开腹,术前拟行胆囊管入路组19例,实际完成13例,6例中转为胆总管入路;胆总管组均按术前计划完成手术;两组手术时间[(153.6±35.5)min vs.(117.9±36.1)min]、探查阴性率[23.08%(3/13)vs.12.50%(4/32)]、T管留置率[38.46%(5/13)vs.100%(32/32)]、住院时间[(9.5±3.0)d vs.(15.4±5.5)d]差异有统计学意义(P<0.05);术中出血量[(32.3±13.5)ml vs.(31.5±15.0)ml]差异无统计学意义(P>0.05);两组术后均无结石残留。结论:两镜联合经胆囊管入路行胆总管探查取石术具有生理功能干扰小、术后康复快、住院时间短等优点。选择合适的病例、术者具有丰富的手术经验、操作器械精良是保证手术成功的关键。     

腹腔镜胆总管切开取石方法探讨

目的 :探讨腹腔镜下胆总管探查胆道取石的方法。方法 :于腹腔镜下对胆总管结石 4 5例按由简单到复杂 ,由损伤轻到损伤重的原则应用冲洗、挤压及分离钳、胆道镜、改良取石钳取石。结果 :用冲吸法取净结石 3例 ,占 6 .6 % ;挤压和分离钳取净结石 13例 ,占 2 8 9% ;胆道镜取净结石 11例 ,占 2 4 % ;取石钳取净结石 18例 ,占 4 0 %。结论 :腹腔镜下胆总管取石应遵循由简到繁的原则 ,用取石钳取石较为可靠     

腹腔镜胆囊切除术治疗胆囊管结石120例分析

目的总结腹腔镜胆囊切除术治疗胆囊管结石的临床经验。方法回顾性分析1995年12月至2009年12月胆囊管结石的腹腔镜胆囊切除术120例的临床资料。结果 120例中,112例手术成功,占93.3%;中转开腹8例。全组无并发症发生。术后随访8～12个月,无胆囊切除术后综合征。结论胆囊管结石的病例绝大多数可在腹腔镜下完成胆囊切除术;疑有胆囊管结石,胆囊管游离要充分,操作切忌粗暴,避免胆管损伤。     

The significance of cystic duct stones encountered during laparoscopic cholecystectomy

Background: Cystic duct stones (CDS) are occasionally encountered during laparoscopic cholecystectomy (LC). They may be noticed during the dissection of the cystic pedicle or seen to extrude from the cystic duct (CD) when it is divided or opened to perform the intraoperative cholangiogram (IOC). The procedures for dealing with CDS range from the simple removal of stones that fall out when the duct is opened to incising the duct over an impacted stone to facilitate its removal or converting to open surgery due to a large stone in a CD adherent to the bile duct (e.g., Mirizzi syndrome). Therefore, we set out to establish criteria that might be predictive of CDS, to examine the technical problems caused by them, to look for the most effective ways of avoiding adverse consequences, especially the risk of missing bile duct stones. Methods: We performed a review and analysis of a database that included preoperative, operative, and postoperative data for all patients treated at our hospital who were found to have CDS. Results: In a series of 520 LC performed over a period of 5 years, 64 cases of CDS were documented (12.3%). The preoperative risk factors in 45 of these cases (70.3%) were recent sever acute pain with or without liver function test (LFT) derangement (34.3%), jaundice (14%), pancreatitis (14%), and previous acute cholecystitis (7.8%). At operation, a single stone was found in the CD in 64% of the cases; multiple stones were found in 36%. Dissection of the pedicle was difficult in 21 cases and had to be carried out fundus-first in four cases. The CD was reported to be wide in 18 cases; five of them eventually needed to be closed with endoloops. Operative difficulty was reported in three of 19 cases where there were no preoperative risk factors. Simple removal of the stones was possible in most cases. CDS needed be crushed, the CD incised, or the procedure converted to open in only five cases (7.8%). IOC was attempted in all cases; it was normal in 39 (61%) and failed in two cases (3%). Eighteen patients (28%) were found to have bile duct stones; another five (7.8%) had CBD dilation or debris indicating possible recent passage of stones. Fourteen transcystic and nine direct bile duct explorations were performed. Conclusion: Some CDS may slip from the gallbladder into the CD or the CBD during dissection. Careful retraction and manipulation should therefore be done to minimize this risk. Most CDS are easy to deal with, but some of them can result in increased operative difficulty. If IOC is not carried out on a routine basis, it becomes mandatory if CDS are encountered because \leq35% of them may be associated with bile duct stones. apd: 13 March 2001