腹腔镜联合纤维胆道镜胆总管探查术21例分析

目的:总结腹腔镜联合纤维胆道镜治疗胆囊结石合并肝外胆管结石的体会,评估“两镜”联合治疗胆石症的临床疗效。方法:回顾分析2002年2月至2006年6月行腹腔镜胆总管切开探查、纤维胆道镜取石、胆道扩张及T管引流术(laparo-scop ic choledochotomy T-tube drainage,LCTD)患者的临床资料。结果:21例中4例术前行ERCP+EST,手术成功20例,手术时间70-180min,平均120min,1例因术中病理示胆囊粘液腺癌,中转开腹行胆囊癌根治术。18例留置T管。患者术后第1天均可下床活动和进食,术后12d行T管造影夹闭T管。术后30-40d(平均34d)拔除T管,2例发生胆漏,其余病例无胆道狭窄、胆道出血和残余结石等手术并发症。1例术后2个月胆管结石复发经T管窦道取石。结论:腹腔镜胆总管探查术具有创伤轻、患者痛苦小、康复快、腹腔脏器干扰少等优点,同时能取得与开腹手术相同的治疗效果,是目前微创治疗胆囊结石并复杂性胆管结石较理想的方法。

Analysis of laparoscopy combined with fibercholangioscopic choledochotomy in 21 cases

Objective:To summarize the experiences of laparoscopy combined with fibercholangioscopy for the treatment of cholecystolithiasis and choledocholithiasis and evaluate the clinical curative effect of the method.Methods:The clinical data of 21 cases undergone laparoscopic choledochotomy and T-tube drainage were retrospectively analyzed.Results:Among 21 cases,4 patients were performed ERCP and EST preoperatively,and operations were succeeded in 20 cases.The operating time was 70-180min(average,120 min).One case was converted to laparotomy because gallbladder mucinous adenocarcinoma was diagnosed by frozen pathological section.T-tube was indwelled in choledochus in 18 cases.Patients could get out of bed and take food on the first day after operation.T-tube visualization and occlusion could be performed in the 12th day,and T-tube was pulled out in 30-40 days(average,34 days)after operation.Bile leakage was found in 2 cases,but no postoperative complications happened in the others,such as stenosis of the biliary tract,hematobilia and residual stone.Calculus of bile duct recurred in 1 case in 2 months after operation,and was removed by fibercholedochoscope through T-tube sinus tract.Conclusions:The laparoscopic choledochotomy has many advantages,such as minor damage,less suffering,rapid recovery and less dysfunction of visceral organs,and can achieve the same effects as laparotomy,and is a better minimally invasive treatment for cholecystolithiasis and complicated choledocholithiasis.