腹腔镜手术治疗胆管结石的临床研究

目的:减轻因开腹手术对腹腔内脏器的干扰和对全身的打击,彻底取尽胆管内结石,并尽可能修复已狭窄的胆管。方法:自1997年7月至2003年2月,共收治200例肝外或肝内外并存结石,均采用腹腔镜下胆总管剖开取石后置T管,胆道镜手术中取石后置T管。术后胆道镜取石,或术中胆总管1期缝合。术后球囊导管扩张或YAG激光修复胆管狭窄。结果:肝内外胆管结石在术中或术后均完全取净,无结石残存,随访3个月～3年无复发。结论:腹腔镜治疗肝内外胆管结石能达到微创目的,避免传统开刀手术给患者带来的创伤,缩短住院及治疗时间。这种微创手术方法应作为胆管结石治疗的首选方法。术后胆道镜检查胆管内有无残存结石,是最为可靠的方法。

Study exploration of laparoscopic for the treatment of the bile duct calculus

Objective To minimize the influence of intraperitoneal organs during operation and the strike to the body,and take out the calculus in bile duct thoroughly,and repair the limited bile duct.Method This article collected200patients with exohepatic and intrahepatic bile duct calculus who have in-patient therapy during July1997to Oct2002,all the cases were taken out the calcu-lus by laparoscopy or cholangioscope,then laid the T tube,after a certain period time ,were taken out the calculus by Cholangio-scope.Using the sacculus conduit to expand and using the YAG laser to repair the limited bile duct.Results The exohepatic and intrahiepatic bile duct calculus were taken out thoroughly during the operation or post-operation,no calculus were left,no recurrence after3months to3years follow-up survey were found.Conclusion The laparoscopic therapy to exohepatic and intrahepatic bile duct calculus can achieve minitrauma,and avoid the trauma taken by the traditional technique,shorten the in-patient therapy time,elim-inate the remained calculus.The laparoscope should be of choice to the therapy of bile duct calculus by cholangioscope during post-operation is a reliable therapy method,which should be widespreaded.