腹腔镜胆总管切开取石术的临床体会

目的 探讨腹腔镜胆总管切开术的方法、注意事项、并发症防治。方法 对该组31例LCBDE的回顾性总结，采用了挤压法、冲洗法、钳夹及常规取石器械取石及胆道镜取石，经历了两个学习操作体会阶段。结果 27例完成LCBDE（其中1例术后因胆漏当晚再次开腹探查），4例分别因T管脱出、粘连、怀疑肿瘤及结石较大不能取出而中转开腹。结论 LCBDE的开展必需要有熟练的腹腔镜操作技术，及必要的硬件设备。对病例有一定的选择，要注意术中的一些操作细节以确保手术成功，强调术后放置T管的必要性。

Clinical experience of laparoscopic common bile duct exploration

Objective] To discuss the methods technological topic and prevention of complications of laparoscopic common bile duct exploration. Methods] The clinical data of 31 patients who underwent laparoscopic common bile duct exploration were reviewing summarized,extruding,washing, tong, common appliances of take-stone, choledochofiberscope were used in the operations; during the period we experienced two stages of study and operating. Results] 27 patients were successfully performed operations under laparoscopic combined with choledochofiberscopy (1 patient was operated openly again for bile leak of post-operation ); four patients were converted to open surgery respectively for T tube prolapsus, conglutination, suspicious cancer, large incarcerated stone. Conclusions] The operations of laparoscopic common bile duct exploration should have skilled techniques and necessary instruments; to ensure the success of laparoscopic common bile duct exploration, we should pay more attention to the details in the operations and choose the reasonable cases.meanwhile the importance of T tube drainage was emphasized.