腹腔镜联合胆道镜治疗65岁以上老年患者胆总管结石56例临床分析

目的 探讨腹腔镜治疗老年人肝内外胆管结石的方法。方法 采用腹腔镜胆总管切开探查取石，术中行胆道镜取石、T型管引流术或胆总管一期缝合术。结果 本组56例，腹腔镜胆总管探查取石、胆总管一期缝合19例，腹腔镜胆总管探查取石、T型管引流37例，其中术后胆道残余结石10例。1次胆道镜取尽结石5例，2次胆道镜取尽结石2例，3次胆道镜取尽结石2例，4次胆道镜取尽结石1例；手术全部取得成功。结论 根据肝胆管结石的部位，选择不同的腹腔镜手术方式，手术是安全可行的，但术中取石仍是腹腔镜手术的难点所在，需要进一步探索加以改进。

Clinical analysis of laparoscopic operation combined with choledochoscopy in treatment of 56 cases 65 years old patients with choledocholithiasis

Objective] To explore methods indications and clinical value of laparoscopic operation combined with choledochoscopy in treatment of old patient choledocholithiasis. Methods] Laparoscopic bile duct exploration and extraction of bile duct was adopted in order to clear the stones T tube drainage was applied or was directly sutured. Results] There are 56 patients in this group. Twenty-five patients applied laparoscopic bile duct exploration and extraction with T tube drainage. Eleven applied laparoscopic bile duct exploration and extraction without T tube drainage. There were 8 patients existed residual stones among them. The residual stones were cleared up by choldochoscope. All operations succeed. Conclusion] The laparocopic operations were safe and feasible if different operated methods were selected probably according to different location of stones. Extraction of stones in laparoscpic operation was still difficulty and need to further study and improved.