腹腔镜经胆囊管胆总管探查取石术的临床分析

目的:探讨腹腔镜经胆囊管胆总管探查术(laparoscopic transcystic common bile duct exploration,LTCBDE)的经验及其应用价值。方法:回顾分析2014年8月至2016年6月为65例胆囊结石合并胆总管结石患者行LTCBDE的临床资料。结果:63例成功完成LTCBDE,其中14例采用胆囊管汇入部微切开技术;2例因操作困难改行切开胆总管前壁取石。2例患者术中胆道镜探查未发现结石。1例患者术后2个月因腹痛行胆道磁共振检查提示胆总管结石,结石残余率1.6%,行内镜逆行胰胆管造影+内镜十二指肠乳头括约肌切开术处理。术后63例患者随访3~19个月,无腹痛、发热、黄疸等异常发现。结论:LTCBDE需要选择合适的患者,只有严格把握手术适应证,才能最大限度地发挥LTCBDE的优势。

Clinical analysis of laparoscopic transcystic common bile duct exploration

Objective:To discuss the experience and application value of laparoscopic transcystic common bile duct exploration (LTCBDE).Methods:Retrospective analysis was made on the clinical data of 65 patients who suffered from choledocholithiasis and cholecystolithiasis and underwent LTCBDE from Aug.2014 to Jun.2016.Results:LTCBDE was successful in 63 patients,14 cases completed cystic duct micro-incision combined with laparoscopic common bile duct exploration.2 cases were converted to common bile duct approach.No stones were found in the common bile duct in 2 patients during surgery.After two months,one patient underwent the magnetic resonance cholangiopancreatography because of postoperative abdominal pain,and stones were found in common bile duct of this patient,the rate of residual stones was 1.6％ (1/63),this patient then received endoscopic retrograde cholangiopancreatography + endoscopic sphincterotomy.After surgery 63 patients were followed up for 3 to 19 months.There were no abdominal pain,fever,jaundice or other abnormal findings.Conclusions:LTCBDE requires appropriate patient.Only strict grasping the indications of LTCBDE can help surgeons maximize the benefits of LTCBDE.