腹腔镜联合经皮肾镜超声碎石吸引在胆道结石治疗中的应用体会

目的:探讨腹腔镜联合经皮肾镜超声碎石吸引治疗胆道结石的可行性与安全性。方法:回顾分析2009年2月至2012年12月为96例胆道结石患者行腹腔镜联合经皮肾镜超声碎石吸引术的临床资料。结果:95例成功完成手术,1例因胆总管出血中转开腹。47例肝内外胆管结石患者,其中19例一期缝合胆总管,28例放置T管引流。手术时间平均(65±30)min,术中出血量平均(30±20)ml,术后平均(25±7)h胃肠功能恢复,平均(18±6)h下床活动,腹腔引流管于术后(48±24)h拔除;无一例发生胆漏。术后1周复查发现1例肝内胆管结石残留,胆道镜下成功取出残余结石,术后平均住院(5.5±2.5)d。术后平均随访(24±18)个月,无结石复发及胆道相关并发症发生。结论:腹腔镜联合经皮肾镜超声碎石吸引在胆道结石治疗中发挥了重要作用,可有效解决结石取出困难、残留,反复取石导致的损伤、出血,手术时间长等问题。

The application of iaparoscopic combined percutaneous nephroscope vlrasonic lithotripsy drainage in the treatment of biliary calculi

Objective：To study the feasibility and safety of laparoscopic combined pereutaneous nephroseope uhrasonic litho- tripsy drainage in the treatment of biliary calculi. Methods：The clinical data of 96 patients who suffered from biliary calculi and under- went laparoscopic combined percutaneous nephroscope ultrasonic lithotripsy drainage from Feb. 2009 to Dec, 2012 were retrospectively analyzed. Results：Among all the 96 cases,95 operations were finished successfully. 1 case was converted to laparotomy because of cho- ledoch hemorrhage. Among the 95 cases, there were 47 cases of intra- and extra-hepatic bile duct stone, 19 cases underwent primary su- ture of common bile duct, and 28 cases received T tube drainage. The mean operation time was （65 ± 30） min, intraoperative blood loss was （ 30± 20） ml, postoperative recovery time of gastrointestinal function was （ 25 ± 7 ） h, ambulation time ＇after surgery was （ 18± 6 ） h, peritoneal drainage tube was removed after （48± 24） h. No patients suffered from bile leakage. One ease of intrahepatic bile duct residual stones was found one week after operation, and residual stones were successfully removed by eholedochoseopy. Postoperative hospital stay was （ 5.5 ±2.5 ） d. During the follow-up of （24± 18 ） months, no biliary complications or stone recurrence were tound. Conclusions：Laparoscopic combined percutaneous nephroscope ultrasonic lithotripsy drainage plays an important role in the treatment of biliary calculi. It can help take out the stones effectively. It can also avoid residual stones, trauma and bleeding caused by removing stones repeatedly, and long operation time.