腹腔镜胆总管探查取石术在老年人再次胆管结石手术治疗中的应用

目的 探讨腹腔镜胆总管探查取石术（LCBDE）在老年人再次胆管结石手术治疗中的效果及安全性.方法 对58例老年再发胆管结石患者行LCBDE,气腹压力维持在12 mmHg,分离腹腔脏器与腹壁的粘连,沿肝脏面向下钝锐性交替解剖,认清胆囊床的位置,其左下方可找到胆总管,穿刺抽出胆汁确定,纵行切开胆总管,自切开处取石钳或胆道镜探查取石,胆总管切开处常规置T管,winslow孔旁常规放腹腔引流管一根.结果 58例患者中有3例因十二指肠与胆总管粘连致密中转开腹手术,余55例均顺利完成LCBDE.手术中出血量35～230 ml,平均85 ml;手术时间90～235 min,平均165 min;术后住院时间7～10d,平均为8d.结石残留一例,7周后经T管窦道电子胆道镜完成取石.并发胆漏一例,经winslow孔旁引流保守治疗后治愈.无肝、胃、肠管损伤和继发急性胰腺炎等并发症.结论 腹腔镜下胆总管探查取石术治疗老年人再发胆管结石具有创伤小、并发症少、恢复快、残留结石率低等优势,是一种安全有效、微创的手术方式.

Application of laparoscopic common bile duct exploration lithotomy in the reoperation of elderly patients with bile duct stone

Objective To investigate the effect and safety of laparoseopic common bile duet exploration li- thotomy in the reoperation of elderly patients with bile duet stone. Methods Fifty-eight elderly patients with recur- rence of bile duet stone were treated with laparoseopie common bile duct exploration lithotomy, with pneumoperitone- um pressure at 12 mmHg. We separated the adhesion of abdominal wall and organs, dissected along liver visceral sur- face with blunt and sharpness methods, reeognizeed the location of the gallbladder bed, found the common bile duct in it＇s lower left, then punctured and drew out bile, dissect the common bile duct longitudinally, and performed lithotomy with forceps or choledochoseope. As routine, we placed a T-shape drainage tube in common bile duct, and placed an- other abdominal drainage tube in winslow＇s hole. Results Threeed out of the 58 patients received laparotomy be- cause of density adhesion between the common bile duct and the duodenum, 55 received laparoscopic common bile duct exploration lithotomy successfully. Intraoperative blood loss ranged from 35 ml to 230 ml, with an average of 85 ml. Operation time ranged from 90 min to 235 min, with an average of 165 rain. Postoperative hospital stay ranged from 7 d to 10 d, with an average of 8 d. One case of calculi residual was treated by electronic choledochoscope lithot- omy through T tube fistula. One case complicated with bile leakage received conservative treatment with drainage tube placed in Winslow＇s hole and was cured completely. No damage was found to liver, stomach, bowel, with no com- plications such as secondary acute pancreatitis. Conclusion Laparoscopic common bile duct exploration lithotomy is characterized by small trauma, fewer complications, rapid recovery and low residual stone rate, which is a safe, effective and minimally invasive surgical procedure for elderly patients with recurrent bile duct stone.