腹腔镜手术治疗胆囊管结石策略

目的探讨胆囊管结石的术前诊断以及腹腔镜胆囊切除术(Laparoscopic Cholecystectomy,LC)中对胆囊管结石的诊断和处理技巧。方法回顾性分析该院自2010年6月—2013年6月腹腔镜手术处理的18例胆囊管结石的临床资料。我们用挤推法、胆囊管切开法处理胆囊管结石,用钛夹和丝线闭合胆囊管残端。结果在185例LC中发现胆囊管结石18例(9.73%);其中术前B超诊断1例、LC后立即在手术室中B超诊断2例、术中确诊15例;遗留胆总管残石1例,中转开腹2例;随访2个月~2年,无胆管损伤、胆瘘等并发症。结论胆囊管结石术前、术中易漏诊;手术结束前B超有助于及时发现胆囊管残石;术者在LC中必须仔细检查胆囊管,丰富的经验和技巧是诊断和处理胆囊管结石的关键因素。

Clinical Experience on Laparoscopic Treatment of Cystic Duct Stones

Objective To study the preoperative diagnosis of cystic duct stones and the ways for the diagnosis and treatment of cystic duct stones in laparoscopic cholecystectomy（LC）. Methods The clinical data of 18 patients with cystic duct stones underwent laparoscopic cholecystectomy in our hospital from June, 2010 to June, 2013 were analyzed retrospectively. Push method was used to remove the stones from the cystic duct into the gall bladder. If failed,the cystic duct above the stones was cut to remove the stones,and then the stump was closed with a clip.If the stump was thick and short,silk sutures were used to narrow the lumen before closing with clips. Results Of the 185 patients underwent LC, there were 18 cases with cholecystic duct stones（9.73%）. Among them, 1 case was diagnosed by preoperative B ultrasound, 2 cases were diagnosed by B ultrasound just after LC in the operating room, 15 cases were diagnosed during the operations, bile duct residual stone was occurred in 1case, and 2 cases were converted to open operation. The patients were followed up for 2 months to 2 years without bile duct injury and biliary fistula. Conclusion Cystic duct stone can be easily misdiagnosed preoperatively and intraoperatively. Ultrasound just after LC in operating room may be helpful to discover residual cystic duct stones in time. The cystic duct must be examined carefully during LC. Rich experiences and good surgical skills are the keys to diagnosis and treatment during LC for cystic duct stones.