开腹胆道取石钳在腹腔镜胆总管探查、处理下段结石嵌顿中的应用价值

目的探讨开腹胆道取石钳在腹腔镜胆总管探查处理下段结石嵌顿中的应用价值。方法回顾性分析我院2015年3月至2018年2月收治的35例胆总管下段结石嵌顿患者的临床资料,患者均行腹腔镜下胆总管探查、开腹胆道取石钳取石、留置T管。结果 29例术中取净结石,术后6周拔T管;2例中转开腹,取Kocher切口,将结石向上挤压移动至胆总管上段,取出结石;4例术后残留结石,术后6周经胆道镜取石,拔T管。无医源性胆管、胰腺、十二指肠损伤发生。随访1～34个月,中位随访时间13个月,无反流性胆管炎、胆管狭窄发生,1例胆总管结石复发。结论腹腔镜胆总管探查中,应用开腹胆道取石钳能较好地治疗胆总管下段结石嵌顿,是一种简便、实用的手术方法。

Application value of open bile duct stone clamp in laparoscopic common bile duct exploration and treatment of lower stone incarceration

Objective To discuss the application value of open bile duct stone clamp in laparoscopic common bile duct exploration and treatment of lower stone incarceration. Methods The clinical data of 35 patients with incarceration of lower common bile duct stones admitted in our hospital from March 2015 to February 2018 were retrospectively analyzed. All patients underwent laparoscopic common bile duct exploration, calculus removed by open bile duct stone clamp and T tube indwelling. Results Stones were completely taken out intraoperatively in 29 cases, with T tube removed at 6 weeks after operation. Two cases were converted to laparotomy, Kocher incision was taken and the stones were moved upward to the upper part of the common bile duct to remove the stone. Residual stones were found in 4 patients and were removed by choledochoscopy at 6 weeks after operation, with T tube removed. There were no iatrogenic bile duct, pancreas and duodenum injuries occarred. Follow-up ranged from 1 to 34 months, with a median follow-up period of 13 months, no reflux cholangitis or bile duct stricture occurred, and 1 case of common bile duct stones recurred. Conclusion In laparoscopic common bile duct exploration, the application of open bile duct stone clamp can better treat the incarceration of lower common bile duct stones, which is a simple and practical surgical method.