两镜联合下胆囊管入路胆总管探查取石的体会

目的:探讨腹腔镜联合胆道镜经胆囊管行胆总管探查取石的手术方法、临床效果及手术体会。方法:回顾分析2011年1月至2013年1月为45例患者行两镜联合胆总管探查取石术的临床资料,根据术前影像学检查分为两组,其中胆囊管入路组13例(A组),胆总管入路组32例(B组),对比分析两组手术时间、术中出血量、探查阴性率、T管留置率、住院时间、术后残石率等指标。结果:两组均无中转开腹,术前拟行胆囊管入路组19例,实际完成13例,6例中转为胆总管入路;胆总管组均按术前计划完成手术;两组手术时间(153.6±35.5)min vs.(117.9±36.1)min]、探查阴性率23.08%(3/13)vs.12.50%(4/32)]、T管留置率38.46%(5/13)vs.100%(32/32)]、住院时间(9.5±3.0)d vs.(15.4±5.5)d]差异有统计学意义(P<0.05);术中出血量(32.3±13.5)ml vs.(31.5±15.0)ml]差异无统计学意义(P>0.05);两组术后均无结石残留。结论:两镜联合经胆囊管入路行胆总管探查取石术具有生理功能干扰小、术后康复快、住院时间短等优点。选择合适的病例、术者具有丰富的手术经验、操作器械精良是保证手术成功的关键。

Experience in choledochoscopic combined with laparoscopic common bile duct exploration and lithotomy through cystic duct

Objective：To investigate surgical procedure, effect and experience of choledochoscopic combined with laparoscopic common bile duct exploration and lithotomy through cystic duct. Methods：Between Jan. 2011 and Jan. 2013,45 patients underwent cho- ledochoscopic combined with laparoscopic common bile duct exploration and lithotomy, and were divided into 2 groups based on the pre- operative imaging examination ：13 cases of cystic duct approach were in group A and 32 cases of common bile duct approach were in group B. Difference of operation time, intraoperative blood loss, negative rate of exploration, T tube indwelling rate, hospital stay, postop- erative residual stone rate was compared between two groups. Results：No patients were converted to laparotomy in two groups. 13 cases in cystic duct group （19 cases） actually completed operation ,6 cases were converted into common bile duct approach. Operations in common bile duct group were successfully completed according to the plan. Operation time between cystic duct group and common bile duct group were （ 153.6± 35.5 ） min vs. （ 117.9 ± 36.1 ） min （ P 〈 0.05 ）. Intraoperative blood loss were （ 32.3 ± 13.5 ） ml vs. （31.5±15.0） ml （P 〉0.05） ,negative rate of exploration was 23.08% vs. 12.50% （P 〈0.05） ,T tube indwelling rate were 38.46% vs. 100% （P 〈0.05）. Hospital stay were （9.5 ± 3.0） d vs. （15.4 ±5.5） d （P 〈 0.05 ）. Two groups had no postoperative residual stone cases. Conclusions：Common bile duct exploration and lithotomy by choledochoscope combined with laparoscope through cystic duct has the characteristics of little interference in physiological functions, quick recovery and short hospital stay. Appropriate se- lection of cases, rich operation experience and excellent operating equipments are the keys to ensure a successful operation.