腹腔镜手术治疗胆囊管结石142例

目的总结胆囊管结石的腹腔镜手术处理技巧。方法 2000年2月～2011年6月对142例胆囊管结石行腹腔镜胆囊切除术。术中常规采用胆囊管挤捏法,将胆囊管结石挤入胆囊内;若失败,则切开结石上方处部分胆囊管,取出结石,残端钛夹夹闭;若残端较粗、偏短,丝线结扎缩小管腔后再用钛夹夹闭或Hem-o-lok结扎钉夹闭。结果 142例完成LC,无中胆管损伤、大出血及胆管结石残留等严重并发症。术后6例发生胆漏,引流2～3周胆漏停止,拔除引流管痊愈。142例术后随访3～12个月,平均6个月,未发生胆道狭窄、胆总管结石及术后出血等严重并发症。结论术中仔细探查胆囊管,警惕胆囊管结石的存在,熟练掌握胆囊管挤捏法、胆囊管部分切开法及胆囊管预先结扎法等手术技巧是腹腔镜胆囊管结石手术成功的关键。

Laparoscopy for Bile Duct Stones: Report of 142 Cases

Objective To summarize the techniques and skills in laparoscopic surgery for bile duct stones.Methods We analyzed the clinical data of 142 cases of bile duct stones,who received laparoscopic cholecystectomy(LC) from February 2000 to June 2011 in our hospital.Gall bladder extrusion and pinch were used to drive the calculus from the bile duct into the gall bladder.If failed,the bile duct above the stones was cut to removed the stones,and then the stump was closed with a titanium clip.If the stump was thick and short,silk sutures were used to narrow the lumen before closing with titanium clip or Hem-o-lok ligation nail. Results No injury to the bile duct,massive hemorrhage,or residual bile duct stones occurred.Six patients developed bile leakage,and then were cured by drainage in 2-3 weeks.The 142 patients were followed up for 3-12 months with a mean of 6 months,during which no bile duct stenosis,common bile duct stones,or postoperative hemorrhage occurred. Conclusions The bile duct must be examined carefully during LC in case of bile duct stones.The keys to LC for bile duct stones include gallbladder tube extrusion and pinch,partial incision and ligation of the bile duct in advance.