腹腔镜下经胆囊管造影网篮胆总管结石取出术

目的探讨腹腔镜胆囊切除时经胆囊管取出胆总管结石的可行性. 方法回顾性分析2003年1月～2004年7月经胆囊管胆道造影18例的临床资料.腹腔镜下切除胆囊之前切开胆囊管,插入造影管行胆道造影,发现胆总管结石后,经胆囊管插入金属网篮,取出胆总管结石. 结果经胆囊管行胆总管造影18例,发现胆总管结石11例,其中2例因结石明显大于胆囊管直径,2例因导管无法经胆囊管进入胆总管,1例因结石嵌顿于壶腹部套篮无法套取结石而放弃腹腔镜下经胆囊管胆总管结石取出,余6例成功完成腹腔镜下经胆囊管胆总管结石取出术.6例随访6～18个月,B超检查未发现胆总管结石残留,无胆总管狭窄或扩张. 结论腹腔镜下经胆囊管胆总管结石取出术可作为部分继发性胆总管结石的术中诊断和治疗手段.

Laparoscopic transcystic common bile duct exploration

Objective To investigate the feasibility of transcystic removal of common bile duct stones during laparoscopic cholecystectomy. Methods Clinical data of 18 cases of transcystic cholangiography during laparoscopic cholecystectomy from January 2003 to July 2004 were retrospectively reviewed. Before the resection of the gallbladder, the cystic duct was opened to insert a catheter for cholangiography. After the common bile duct stones were detected, a wire basket was introduced transcystically to remove the stones. Results Transcystic cholangiography was conducted in 18 cases, 11 of which were detected as having common bile duct stones. Of the 11 cases, laparoscopic transcystic common bile duct exploration was successfully completed in 6 cases and failed in 2 cases with stones significantly larger than the diameter of the bile duct, 2 cases of failure of transcystic insertion of catheter, and 1 case with stones embedded in the hepatopancreatic ampulla. Follow-up with B-ultrasonography for 6~18 months in the 6 cases revealed no residual stones,biliary stricture,or bile duct dilatation. Conclusions Laparoscopic transcystic common bile duct exploration (LTCBDE) provides an effective option for the diagnosis and treatment of secondary common bile duct stones during laparoscopic cholecystectomy without opening the common bile duct.