腹腔镜胆总管探查取石术178例临床分析

目的:探讨腹腔镜胆总管探查取石术(laparoscopic common bile duct exploration,LCBDE)治疗胆总管结石的手术方式及并发症处理措施。方法:回顾分析2005年6月至2012年1月为178例胆总管结石患者行LCBDE的临床资料,分析术前评估、取石方式、腹腔镜及胆道镜技术对疗效的重要性,总结胆总管末端损伤、结石残留、胆漏等并发症发生原因及处理措施。结果:一期吻合123例,其中3例先行十二指肠镜鼻胆管引流;留置T管55例,其中13例中转开腹取石、补漏。术后发生胆漏5例,引流3～7 d愈合,平均(5.3±1.5)d。术后随访3～60个月,平均(36.0±18.6)个月,无胆漏、胆管狭窄、胰腺炎发生;5例结石复发,行乳头括约肌切开取石术。结论:腹腔镜联合胆道镜胆总管探查取石术治疗胆总管结石安全、可靠;术前正确评估,术中正确取石,避免盲目、暴力操作,术中并发症及早发现、及时治疗是手术成功的重要保证。

The clinical analysis of 178 cases about laparoscopic common bile duct exploration

Objective:To investigate the surgical methods and managements of complications of laparoscopic common bile duct exploration(LCBDE) in the treatment of common bile duct stones.Methods:The retrospective analysis was made on the clinical data of 178 patients who had suffered from common bile duct stones and underwent LCBDE from Jun.2005 to Jan.2012,the importance of preoperative evaluation,patterns of calculus removed and laparoscopic choledochoscopic technology for curative effects were analyzed,the causes and management of complications,such as injury to the end of the common bile duct,residual calculi,bile leakage were summarized.Results:The 123 cases were cured with primary suture after LCBDE and 3 cases of whom underwent endoscopic naso-biliary drainage first;55 cases were cured with T-tube drainage and 13 cases of whom were converted to open cholelithotomy for repair of bile leakage.5 patients suffered from postoperative biliary leakage were cured with abdominal drainage for 3 to 7 days,mean(5.3±1.5) d.During a follow-up of 3 to 60 months,mean(36.0±18.6) months,there were no bile leakage,bile duct stricture,or pancreatitis;5 cases of recurrence of stones were cured by endoscopic sphincterotomy.Conclusions:Laparoscope combined with choledochoscope in common bile duct exploration is secure and reliable in dealing with choledocholithiasis.Followings are important guarantees for the operation:proper preoperative assessment,exact exploration,avoiding blind and violent operation,early detection and timely treatment of intraoperative complications.