小切口开腹手术联合胆道镜胆总管探查：附296例报告

目的探讨小切口开腹手术联合胆道镜胆总管探查术的手术方法及价值。方法回顾性分析开腹手术联合胆道镜胆总管探查术296例的临床资料，其中胆囊结石并继发胆总管结石253例，胆道蛔虫4例，Mirizzi—Ⅰ综合征6例，急性化脓性胆管炎23例，急性胰腺炎21例，乳头良性狭窄17例。全组中胆总管切开胆道镜取石一期缝合23例，经胆囊管纤维胆道镜探查网篮取石18例，未放置T管引流，其余均行胆总管切开，胆道镜取石，T管引流术。结果296例均顺利完成手术。手术时间40～165（平均55）min；其中取石时间18（10～40）min。223例75．3％]术后能在次日下床活动，开始进流质饮食。一次性使用止痛剂62例（21．0％）。住院时间8～20d。结论小斜切口开腹手术联合胆道镜胆总管探查术具有创伤轻、痛苦小、恢复快、安全有效、并发症少等优点，有推广应用价值。

Mini laparotomy incision combined with choledochofiberoscopy for common bile duct exploration: a report of 296 cases

Abstract:Objective:To investigate the effects and methods of mini laparotomy incision operation combined with choledochofiberoscopy in common bile duct (CBD) exploration.
Methods :The clinical data of 296 patients who underwent laparotomy operation combined with choledochofiberoscopy in common bile duct exploration were analyzed retrospectively.Among these 296 patients,there were 253 patients with cholecystolithiasis and common bile duct stone, 4 patients with bile duct ascariasis, 6 patients with Mirizzi I syndrome, 23 patients with acute suppurative cholangitis, 21 patients with acute pancreatitis and 17 patients with benign papillary stenosis. There were 23 patients treated with choledochotomy, calculus removal, and primary closure by choledochoscope, 18 patients with CBD exploation and removal of calculi through cystic duct with reticular basket under choledochofiberoscope,and no case with T tube drainage; the others underwent choledochotomy, calculi remove and T tube drainage.
Results:All the cases were operated on successfully,and the average time of operation was 55 (40-165)minutes, including 18(10-40) minutes for removing calculi. Two hundred and tweent three patients were ambulatory and began liquid diet on the next day after operation, and 62 patients used one dose of analgesic. The length of hospital stay was 8-20 days.
Conclusions:The method of the mini laparotomy incision combined with choledochofiberoscopy in common bile duct exploration has the advantages of less trauma, less pain,low complication rate and rapid recovery,and it is also safe and effective. It is worthy of widespread use.