选择性经胆囊管胆总管探查取石22例

目的探讨开腹胆囊切除术合并胆总管结石的简便微创治疗方法。方法对开腹胆囊切除时明确或怀疑合并胆总管结石患者．术中胆道造影后，选择合适病例不切开胆总管，经扩张的胆囊管行胆总管探查取石。结果22例患者采用此方法，占同期胆总管探查手术的9．6％（22／230），成功发现并取出结石29枚，平均1．4枚，未放量T管，术中无胆道损伤及出血，术后无胆总管结石残留。结论根据术前检查，术中胆道造影及胆囊管粗细情况，选择合适病例，经胆囊管胆总管探查取石，不需特殊设备和技术要求，安全性高，并发症低，无结石残留，费用少，对于基层医院可作为胆总管结石治疗的一种微创技术的选择。

Common Bile Duct Calculi Extraction Selectively through Cystic Duct in 22 Cases

Objective To evaluate the clinical significance of the minimally invasive technique in the combined common bile duct stones in open cholecystectomy. Method For the patients who were diagnosed or highly suspected with combined common bile duct stones at open choleeystectomy, the cystic ducts were dilated without curing common bile duct transcystic common bile duct（CBD） exploration and extraction of complicated CBD calculi after intraoperative cholangiograph. Results 22 patients were treated with this method, accounting for 9.6% （22/230） at the same period of common bile duct exploration surgery, 29 stones successfully explorated and removed with an aver age of 1.4 stones, no T tube placement and intraoperative bile duct injury and non-bleeding, no residual common bile duct stones. Conclusion According to the preoperative examination, intraoperative cholangiography and thickness of the cystic ducts to select the appropriate cases, most of the patients with CBD calculi can be treated successfully by means oftranscystic duct common bile duct exploration technique without special requirements of equipment and technique, with high safety, low complications, no residual stones and less cost, which is a better minimally invasive technique for treatment of choledocholithiasis in local hospitals.