腹腔镜胆管探查1273例报告

目的总结腹腔镜胆管探查术的临床应用经验。方法回顾性分析1992～2007年我院已开展的腹腔镜胆管探查（LCBDE）1273例的临床资料。结果 1273例中有1260例成功施行了LCBDE。因术中难以控制的出血、肝胆肿瘤、胆管损伤、Mirizzi综合症、胆管结石巨大难以取出、肝十二指肠韧带解剖困难、胆总管直径过细、腹腔镜胆肠内引流术失败等原因放弃LCBDE或改为开腹手术13例,手术成功率98.97%（1260/1273）。在成功实施LCBDE的1260例中,安放T管564例,一期缝合690例,腹腔镜下胆肠内引流术6例。术后漏胆42例,其中因T管脱出或腹膜炎加重再行腹腔镜下重置T管5例,余经引流保守治愈。无术中死亡。手术后1个月内死亡7例,均为老年患者。手术病死率0.54%（7/1273）。胆管阴性探查85例,阴性探查率6.75%（85/1260）。术中平均失血30.7ml,平均手术时间147min,术后平均住院时间9.1d。成功病例的治愈好转率99.44%（1253/1260）。结论 LCBDE术是一种有效、安全、适应证广泛的胆管结石的微创治疗方法。在有技术条件的医院,可以作为胆管结石,尤其是肝外胆管结石的首选术式。

A 1273 cases report of laparoscopic common bile duct exploration

Objective To summarized clinical experience of laparoscopic common bile duct exploration.Methods Retrospective analysis clinical data of 1273 samples which were performed laparoscopic exploration of common bile duct in our institution from 1992 to 2007.Results 1260 cases were successful performed laparoscopic common bile duct exploration.13 cases were diverted open operation because of unruly bleeding,liver or bile duct neoplasma,blie duct injuries,Mirizzi syndrome,refractory huge stones,anatomical variation of duodenohepatic ligament,tiny diameter of common bile duct,abortive laparoscopic biliary-intestinal tract internal drainage,et al.operative achievement ratio was 98.97%（1260/1273）.In all 1260 cases,564 cases were implanted tee-pipe,690 cases were performed primary bile duct suture,6 cases were executed laparoscopic biliary-intestinal tract internal drainage.Bile leakage was detected in 42 cases postoperative,in which 5 cases were implanted tee-pipe again because of exodus of tee-pipe or severe peritonitis,the others were cured by perseverative drainage and conservative therapy.No one patient died during operation and 7 senile patient died in one month after operation.Mortality was 0.54%（7/1273）.Negative morbid change was detected in 85 cases,and negative exploration rate was 6.75%（85/1260）.Mean of hemorrhage was 30.7ml,and average of operative time was 147 minute,and average length of stay was 9.1 days.Recovery rate was 99.44%（1253/1260）in operative achievement.Conclusion Indication of laparoscopic common bile duct exploration of bile duct stones was extensive,which was a safety and effective therapeutic method,and which can be preferred method to treat bile duct stone,especially extrahepatic bile duct stone,in salty institute.