腹腔镜下胆总管切开取石一期缝合术

目的探讨腹腔镜下胆总管切开取石一期吻合术的可行性.方法回顾分析从1999年1月～2003年3月行腹腔镜下胆总管切开取石病人116例,其中术前诊断胆囊和胆总管结石84例,腹腔镜胆囊切除术中造影发现胆总管扩张和结石32例.结果107例(92.2%)完成胆总管切开取石、一期缝合术,其中3例(2.8%)术后经ERCP造影发现胆总管残余结石并全部取出,并发症发生率为6.5%,无手术死亡率.2例中转开腹,7例(6.0%)行腹腔镜胆总管切开取石、T管引流术.104例(89.7%)成功完成腹腔镜下胆总管切开一次性取石干净、一期缝合,随访22个月(12～41个月),无结石复发和再次手术病人.结论腹腔镜下胆总管切开取石一期缝合术拓展了微创治疗胆总管结石的新途径,可成为胆总管切开取石的一种标准术式.

Laparoscopic choledochotomies with primary closure to clean common bile duct stones

Objective: To investigate the feasibility for Laparoscopic choledochotomies with primary closure to clean the common bile duct stones. Methods: From January 1999 to March 2003, total of 116 patients with common bile duct stones (CBDS) were performed by laparoscopic choledochotomy. It was found in 84 patients with gallbladder and common bile duct stones and in 32 patients at laparoscopic cholecystectomy with intraoperative cholangiogram for the CBD dilatation and CBDS. Results: 107 of 116 patients (92.2%) were successfully performed by laparoscopic choledochotomy with primary closure of the CBD. With a complication rate of 6.5% and no mortality. Retained bile duct stones have been found on postoperative cholangiogram in 3 patients (2.8%) and all of them have been successfully removed by postoperative ERCP. 2 patients were conversed to open technique and 7 patients (6.0%) were performed by laparoscopic common bile duct exploration with T-tube drainage. Thus 104 patients (89.7%) had their bile duct successfully cleaned by one-step technique alone, without residual stones and reoperation with a follow up of 22 months (range 12~41 months). Conclusions: Laparoscopic choledochotomy with primary closure might extend the possibilities of laparoscopic treatment for CBDS. It shall be a standard operation for patients with CBD stones.