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。

Surgical skills of laparoscopic bile duct exploration lithotomy with intra-operative choledochoscope transcystic duct approach

Objective To explore the surgical skills of laparoscopic common bile duct exploration lithotomy transcystic duct approach. Methods Retrospective analyses were conducted for the surgical experiences of 897 cases of laparoscopic transcystic duct common bile duct exploration （LTCBDE） in 9 years etween December 2003 and December 2012 at our hospital and analyze the surgical indications, operative procedures and methods of LTCBDE. Results In this group, 841 cases underwent LTCBDE successfully while another 56 cases had laparoscopic choledochotomy exploration with intra-operative choledochoscope and T tube drainage. The average operative duration was （98. 1 ±38. 1） min, postoperative hospitalization （3. 5 ±1.9） days and there was bile leakage （n = 4, 0. 48%）. There was no occurrence of other severe complications. The mean follow-up period was 18. 6 （3-36） months. No bile duct stricture was found. Conclusions The procedure of LTCBDE may incise the confluence of cystic duct and common bile duct and incision dilation. And its advantages are no incision of common bile duct and non-use of T tube.