腹腔镜胆总管探查术的临床分析

目的 探讨腹腔镜胆总管切开取石术(LCBDE)中应用开腹器械取石的可行性.方法 回顾性分析我院36例LCBDE取石的临床资料.胆总管切开后以纤维胆道镜检查确定结石的部位、大小及数量,以常规开腹胆道取石器械进行胆道取石,并与同期3 6例开腹手术进行比较.结果 LCBDE组36例手术均获成功,无中转开腹.常规于术后4周行T管造影,34例示结石取净;胆道残余结石2例,均于术后6周经T管窦道胆道镜取石治愈.在手术时间上,LCBDE组与开腹手术组相比无显著性差异(P＞0.05);术后住院时间较开腹手术组明显缩短(P＜0.05).两组均留置T管,均无胆瘘、胆管狭窄或出血病例,均痊愈出院.LCBDE组36例随访6～4 8个月均无异常.结论 严格选择手术适应证,应用开腹器械进行腹腔镜胆道取石安全有效、操作容易、成本低、手术时间短.

The Clinical Evaluation of Bile Duct Exploration with Laparoscope

Objective To evaluate the feasibility of laparoscopic common bile duct exploration(LCBDE) with open bile duct operative instruments .Methods To analyses 36 cases with LCBDE in our hospital.The choledochoscopy is used to confirm the place,size and numbers of the stones,and stones are removed by open bile duct operative instruments. Then to make cornparison with the result of 36 cases with lithotomy.Results LCBDE in 36cases are successful,none of them was converted to laparotomy.Four weeks after operation,T tube visualization shows:The stones are removed completely in 34 cases and there were residual stones in 2 cases removed by the choledochoscope by T tube sinus 6 weeks after operation.There was no significant in operative time between the two groups(P>0.05).The length of stay in the LCBDE group after operation is less than that of laparotomy group(P <0.05).T tube are placed in both groups,They have no biliary fistula,bile duct stricture and hemorrhage occurred. The LCBDE group do not find no abnormal in 6-48 months.Conclusions Bases on correct operative indication,remove stones with open bile duct operative instruments in LCBDE is the advantages of safety, efficiency,low cost,short operative time and easy performance.