腹腔镜联合胆道镜治疗胆管结石86例临床体会

目的:分析腹腔镜联合胆道镜治疗胆管结石的适用范围、操作要求及应用价值。方法:回顾分析2014年10月至2016年12月收治的86例胆管结石患者的临床资料,其中胆囊结石合并胆总管结石76例,胆囊结石合并肝内外胆管结石10例。为患者行腹腔镜联合胆道镜治疗。结果:86例均成功完成腹腔镜手术,无一例中转开腹。81例行腹腔镜胆囊切除、胆总管探查、T管引流术,5例行腹腔镜胆囊切除术、胆总管探查一期缝合术。手术时间95~160 min,平均(130.5±12.5)min;术中出血量20~200 ml,平均(40.0±8.2)ml;术后住院4~12 d,平均(5.8±1.2)d。术后无出血、胆管狭窄等并发症发生。1例患者发生胆漏,经腹腔引流后顺利出院。结论:在严格的适应证、丰富的腹腔镜手术经验的前提下,应用腹腔镜联合胆道镜治疗胆管结石是安全、可靠的,具有良好的临床疗效。

Laparoscopy combined with choledochoscopy for cholangiolithiasis: clinical experience of 86 cases

Objective:To analyze the indication,operating requirements and application value of laparoscopy combined with choledochoscopy for cholangiolithiasis.Methods:The clinical data of 86 cholangiolithiasis patients from Oct.2014 to Dec.2016 were retrospectively analyzed,including 76 cases of cholecystolithiasis complicated with choledocholithiasis and 10 cases of cholecystolithiasis complicated with intra-and extra-hepatic bile duct calculi.All patients underwent laparoscopy combined with choledochoscopy.Results:All cases were successfully performed without conversion to open surgery.Of all cases,81 cases were treated with laparoscopic cholecystectomy and common bile duct exploration with T tube drainage.The other 5 cases were treated with laparoscopic cholecystectomy and common bile duct exploration with primary suture.Average operative time was (130.5 ± 12.5) min (range,95-160 min);blood loss was (40.0 ± 8.2) ml (range,20-200 ml);postoperative hospital stay was (5.8 ± 1.2) d (range,4-12 d).No bleeding or bile duct stricture occurred.One patient suffered from bile leakage and was discharged from hospital after drainage.Conclusions:On the basis of strict indications and sufficient laparoscopic skills,laparoscopy combined with choledochoscopy is safe and reliable with good clinical efficacy in the treatment of cholangiolithiasis.