腹腔镜胆总管探查术161例分析

目的探讨腹腔镜联合胆道镜在胆总管探查、取石术中的应用价值。方法 2009年1月～2011年1月应用腹腔镜联合纤维胆道镜行腹腔镜胆囊切除术、胆总管切开取石、T管引流术治疗161例胆管结石。结果 161例腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)均获成功,无中转开腹。术后3例发生胆漏,保守治疗4～6 d痊愈。术后住院7～12 d,平均9 d。术后6～8周拔除T管,4例胆管残余结石经T管窦道二期胆道镜取石成功。161随访1～17个月,平均6个月,B超或MRCP复查未发现肝外胆管狭窄,无黄疸、结石复发、胰腺炎等。结论腹腔镜联合纤维胆道镜胆总管探查取石术安全、有效。

Laparoscopic Exploration of the Common Bile Duct:Report of 161 Cases

Objective To evaluate laparoscopy-guided choledochoscopic exploration of the bile duct.Methods The data of 161 patients with bile duct calculi,who underwent laparoscopic common bile duct exploration from January 2009 to January 2011 were collected and analyzed retrospectively.The patients underwent laparoscopic cholecystectomy+LCTD combined with fibrocholedochoscopy.Results The procedure was competed in all the 161 cases,none of the patients were converted to an open surgery.After the operation,3 patients developed biliary leakage and then was cured by conservative therapy for 4 to 6 days.The patients were discharged from hospital in a mean of 9 days(ranged from 7 to 12).T-tube was removed in 6 to 8 weeks after the operation.Four patients showed residual bile duct stones and was cured by a second choledochoscopic surgery through T tube sinus.The patients were followed up for a mean of 6 months(ranged from 1 to 17 months),during which neither B-ultrasonography nor MRCP showed extrahepatic biliary stenosis,jaundice,recurrent calculi,or pancreatitis.Conclusion Laparoscopy-guided choledochoscopic exploration of the bile duct is safe and reliable.