腹腔镜联合胆道镜行胆总管切开取石探查术156例临床体会

目的:总结腹腔镜联合胆道镜行胆总管切开探查取石、T管引流术的临床体会。方法:先行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC),再切开胆总管,用特制的腹腔镜胆总管取石钳取石,胆道镜主要观察胆总管及肝内外胆管有无结石残余及是否通畅,必要时经胆道镜取石。结果:术后拔T管时出现胆漏3例,1例术后10d T管自胆总管脱出至腹腔,1例术后24h胆漏达400ml,6例中转开腹,余均痊愈出院,无残石及术后胆管狭窄等并发症发生。结论:腹腔镜联合胆道镜行胆囊切除、胆总管切开探查取石、T管引流术具有安全可靠、患者损伤小、康复快、住院时间短等优点,是治疗胆囊结石、胆总管结石的有效术式。

Laparoscope combined with choledochoscope in choledochotomy for stone removal and exploration for 156 cases

Objective:To summarize the clinical experience of laparoscope combined with choledochoscope in choledochotomy for exploration,stone removal and T-tube drainage.Methods:Using special laparoscopic lithotomy forceps to remove calculus from common bile duct after laparoscopic cholecystectomy and choledochotomy.Choledochoscope was mainly used to observe whether or not there was any calculi left and the patency of the common bile duct.If necessary,choledochoscope could take the calculi out.Results:After the removal of T-tube,bile leakage occurred in 3 patients,1 case in the tenth day after operation,T-tube prolapsed to abdomen,1 case in the 24h after the operation,400ml bile leaked,6 cases were converted to open operation,all the others were healed without any complications such as calculi left,biliary stricture and so on.Conclusions:Laparoscope combined with choledochoscope in laparoscopic cholecystectomy and choledochotomy for exploration,stone removal and T-tube drainage is safe and reliable.Damage in patients are minor,who recover more quickly and with shorter hospitalization time.This method is feasible in treatment of calculi in gallbladder and bile duct.