腹腔镜和内窥镜联合治疗复发性胆总管结石

目的 :探讨腹腔镜和内窥镜联合治疗复发性胆总管结石的方法。方法 :回顾总结经内窥镜鼻胆管引流术 (ENBD)配合实施腹腔镜胆总管探查 (LCBDE)、Ⅰ期缝合术 (内衬ENBD导管 )治疗胆道术后复发性胆管结石 2 2例的临床资料。结果 :2 1例手术成功 ,1例中转开腹 ,全部Ⅰ期缝合胆总管探查切口。术后无残石及胆瘘等并发症。手术时间 1 5 7± 31 4min ,术后住院 9 6± 1 2d。随诊 1 7例未见复发。结论 :应用腹腔镜和内窥镜联合治疗胆总管复发结石安全、可行 ,体现了微创治疗的优点 ,但分离粘连及解剖、缝合胆总管较困难 ,治疗初期应适当放宽中转开腹手术的指征

Laparoscopy combined endoscopy for postoperative recurrent choledocholithiasis

Objective:To study the method of applying laparoscopy in combination with endoscopy(duodenoscope and choledochoscope)for the treatment of recurrent choledocholithiasis after operation on biliary tract.Methods:The clinical data of 22 cases of recurrent bile duct calculi after operation which received laparoscopic common bile duct exploration (LCBDE)with primary suture employed endoscopic nasobiliary drainage(ENBD)was analyzed retrospectively.Results:Satisfactory outcome was realized except conversion occurred in one for duodenal injury.All cases received primary suture on the incision of CBD.There was neither residual calculi nor serious complication including biliary fistula and hemobilia.The operative time was 157±31 4 minutes.Mean postoperative hospitalization was 9.6±1.2 days.No recurrent stones and bile duct stricture could be traced among 17 patients follow up for 6 36 months.Conclusions:The combined procedure is feasible and safe,but the technique of seperating adhesions,dissecting choledochus,and primary suture on the incision is especially difficult.In early period of laparoscopic procedure,proper conversion was necessary.