腹腔镜联合胆道镜治疗有上腹部手术史的肝外胆管结石63例分析

目的探讨有上腹部手术史病人行腹腔镜联合胆道镜治疗肝外胆管结石的可行性及临床疗效。方法回顾性分析2013年4月至2017年3月期间对63例有上腹部手术史的胆总管结石病人采用腹腔镜胆总管切开探查、术中胆道镜取石、T管引流术或鼻胆管引流胆总管一期缝合术治疗的临床资料。结果腹腔镜手术成功60例;中转开腹3例。16例取石后T管引流,41例取石后放置鼻胆管引流一期缝合胆总管,6例经胆囊管胆总管探查胆道镜取石一期缝合。术后胆漏2例,无出血、腹腔感染等并发症发生。61例随访4~48个月,2例失访,无结石残留、胆管狭窄发生。结论术前影像学的准确评估,术者娴熟的腹腔镜及胆道镜手术技巧,以及对中转手术时机的严格掌控,术后的通畅引流,能够使有上腹部手术史的肝外胆管结石病人在进行腹腔镜联合胆道镜治疗时安全可行。

Laparoscopy combined with choledochoscopy in the treatment of extrahepatic bile duct stones in patients with history of upper abdominal surgery: an analysis of 63 cases

Objective To investigate the feasibility and clinical effect on patients with a history of abdominal surgery undergoing laparoscopy combined with choledochoscopy in the treatment of extrahepatic bile duct stones.Methods The clinical data were retrospectively analyze between April 2013 and March 2017 on 63 cases with abdominal surgery history of common bile duct stones treated by laparoscopic common bile duct exploration,intraoperative choledochoscopy and T tube drainage or nasobiliary drainage of common bile duct suture.Results Laparoscopic operation was successfully performed on 60 cases,and 3 cases were converted to open surgery.Sixteen cases were treated with T tube drainage,41 cases received nasobiliary drainage and one stage suture of common bile duct.Six cases underwent primary suture with common bile duct exploration and choledochoscope through cystic duct.Postoperative bile leakage occurred in 2 cases,and there was no bleeding,abdominal infection and other complications.Sixty-one cases were followed up for 4 to 48 months,and 2 cases were lost.There were no residual stones and bile duct stricture.Conclusions Accurate assessment of imaging before surgery,skilled surgical techniques of laparoscopy and choledochoscopy,and strict control of the transit time of operation and postoperative drainage can make laparoscopy combined with choledochoscopy safe and feasible in the treatment of extrahepatic bile duct stones in patients with a history of upper abdominal surgery.