腹腔镜经胆囊管胆道探查取石术172例临床疗效分析

目的总结腹腔镜联合术中胆道镜经胆囊管胆道探查取石术（1aparoscopictranscysticcommonbileductexplorationwitllcholedochoscope。LTCBDEC）的临床经验。方法对172例胆囊结石合并胆总管继发性结石或可疑病变患者，采用腹腔镜联合术中胆道镜经胆囊管胆道探查取石治疗。结果157例手术成功（91．2％），发现胆总管结石103例，阴性探查54例，7例改行腹腔镜胆总管切开取石T管引流术，5例改行腹腔镜胆总管切开探查I期缝合术，3例中转开腹；平均手术用时95rain（65min-240min）。术后出现胆管残石2例，胆痿7例，戳孔感染3例，出血1例。术后2d～5d拔除腹腔引流管，平均住院时间5．1d（4d-7d）。结论腹腔镜联合术中胆道镜经胆囊管胆道探查取石术微创、安全、有效，并发症发生率低，值得临床推广应用。

Clinical analysis of 172 patients with laparoscopic transcystic common bile duct exploration

Objective To summarize clinical experience of Laparoscopic transcystic common bile duct exptoration with eholedochoseope （ LTCBDEC ） in treating common bile duct lithiasis. Methods LTCBDEC was applied for treating 172 cases choleeystolithiasis combined with diagnosed or suspicious secondary stone in common bile duct. Results 157 cases （91.2%） were undergone LTCBDEC, among which 102 patients were found actual stone in common bile duct while the other 54 cases with negative finding. Other than this, 7 cases were operated by laparoscopic common bile duct insection with ＂T＂ pipe drainage, while dissected common bile duct of other 5 patients were sutured during operation and 3 cases suffered open surgery. Statistically, the mean operation time was 95min （65 min-240 min）. Postoperative complication included 2 cases of residual common bile duct lithiasis, 7 bile leakage, 3 cases portsite infection and 1 intra-abdominal hemorrhage. The post-operative stay was meanly 5.1 d （4 d-7 d ） while drainage pipe extraction time ranged 2-5d after surgery. Conclusion The approach of LTCBDEC in treating common bile duct lithiasis is minimally invasive, safe, effective and has potential to expand its indication in clinical therapy.