腹腔镜联合胆道镜治疗胆管结石160例

目的:探讨腹腔镜联合胆道镜在胆总管切开取石中的应用方法及疗效.方法:回顾性分析1998-01/2006-12我院160例胆总管结石行胆总管探查、胆道镜取石的临床资料.结果:159例在腹腔镜下顺利完成手术,1例中转开腹.胆总管一期缝合68例,置T管92例,术中取尽结石156例,术后胆道镜取石4例.手术时间70-120(平均115)min,术后住院时间4-11(平均6)d.无胆道出血及腹腔感染,无手术死亡.术后胆漏2例.经再次腹腔镜下缝合与引流治愈.120例随访6-36(平均18)mo,无结石复发和远期并发症.结论:腹腔镜联合胆道镜胆总管探查取石术具有创伤小、恢复快、住院时间短的优点,治疗胆总管结石安全有效.

Laparoscopy combined with choledochoscopy for the treatment of bile duct calculi: 160 cases analysis

AIM:To discuss techniques and effects of laparosocopy combined with choledochosopy in choledocholithotomy. METHODS:A retrospective analysis was per- formed of clinical data on 160 patients with choledochlithiasis that were treated with laparo- scopic common bile duct exploration and stone removal with choledochosopy from January 1998 to December 2006 at our hospital. RESULTS:The laparosocopic operation was successfully completed in 159 patients,and a conversion to open surgery was needed in only 1 patient.The primary suture of the bile duct was performed in 68 patients,while T-tube drainage was conducted in 92 patients.The stones were completely removed during the operation in 156 patients;stone removal under choledochosopy was required in 4 patients after the operation. The operation duration was 70-120 minutes (mean,115 minute).The postoperative hospital stay was 4-11 days (mean,6 days).No bile duct hemorrhage or abdominal infection was seen. No fatalities were noted.Postoperative biliary leakage occurred in 2 patients,and both were cured with a second suture and drainage with laparoscopy.Follow-up observations in 120 pa- tients for 6-36 months (mean,18 months) found no recurrence of bile duct stones or long-term complications. CONCLUSION:Laparoscopy combined with choledochoscopy for choledocholithotomy has the advantage of less invasion,rapid recovery and shorter hospitalization.It is a safe and effec- tive method for bile duct stones.