腹腔镜下经胆囊管肝总管汇合部微切开胆总管探查的可行性

目的探讨腹腔镜下经胆囊管肝总管汇合部微切开胆总管探查免置T管的可行性及病例选择。方法回顾性分析我院2009年1月至2011年12月期间52例拟行胆总管探查患者的临床资料，实施了经腹腔镜、胆道镜双镜联合下经胆囊管肝总管汇合部微（3～4mm）切开取石、不放置T管引流，一期缝合。结果本组52例患者术中无阴性探查，术中使用胆道镜及胆道造影检查证实结石完全取出，结石取净率为100％，手术时间为90～200min，平均100min。术中胆道造影时间为3～10min，平均6min。胆道镜协助取石时间为5～15min，平均8min。术后腹腔引流管拔管时间3～5d，平均3．5d。术后腹腔引流液量为20～60mL／d，平均30mL／d。术后无胆汁漏、腹痛、黄疸及切口感染发生。术后住院5～12d，平均6．5d。术后随访时间为3～40个月，平均20个月，无结石再生或胆管狭窄发生。结论若术者腹腔镜、胆道镜技术熟练，手术病例选择适当，术中检查仔细，冲洗干净，经胆囊管肝总管汇合部微切开取石后行胆总管一期缝合是安全、可行的。

Feasibility Through Confluence of Common Bile Duct and Cystic Duct Approach with Mini-Incision in Laparoscopic Common Bile Duct Exploration

Objective To investigate the feasibility and patient selection ofT-tube free laparoscopic common bile duct exploration through mini-incision in confluence of common bile duct （CBD） and cystic duct. Methods The clinical data of 52 patients who underwent CBD exploration from January 2009 to December 2011 were retrospectively analyzed. A 3-4 mm longitudinal incision of anterior wall of CBD was made along the confluence of CBD and cystic duct, and then the choledochoscope was inserted into CBD through this mini-incision for the exploration and treatment by laparoscopy and choledochoscopy, the incision was sewed up by T-tube free primary suture. Results All 52 cases were cured and stone clearance rate was 100% as revealed by choledochoscopy and cholangiography. The time of operation, intraoperative cholangiography, removal of stones with help of choledochoscope, and removal drainage tube after operation was from 90 to 200 min with an average of 100 min, 3 to 10 rain with an average of 6 min, 5 to 15 min with an average of 8 min, and 3-5 d with an average of 3.5 d, respectively. The drainage flow was 20-60 mL/d with an average of 30 mL/d. No biliary leakage, abdominal pain, and choloplania or infection of incision was observed following operation. The hospital stay was 5 to 12 d with an average of 6. 5 d after operation. No calculus regeneration or bile duct stricture occurred during following-up of 3 to 40 months with an average of 20 months. Conclusion With proper patient selection, T-tube free laparoscopic CBD exploration through mini-incision in confluence of CBD and cystic duct is safe and feasible by proficient surgeons in laparoscopy and choledochoscopy.