腹腔镜指导下纤维胆道镜胆总管探查术的临床应用

目的讨腹腔镜指导下纤维胆道镜胆总管探查术可行性及应用价值。方法对具有胆道探查指征的患者,施行腹腔镜下胆总管切开,经此切开处置入胆道镜进行检查和治疗。探查完成后,放置T管或I期缝合胆总管。结果全组施行此术式152例,发现肝外胆管结石141例,术中结石取净率为100%;探查阴性11例。胆道镜检查和/或协助取石时间为8～35 min,平均15 min。152例微创手术均成功,无1例中转开腹,腹腔镜下胆总管Ⅰ期缝合42例,放置T管引流110例,术后3～4周拔T管,无1例结石残留;并发胆瘘2例,未发现有胆道狭窄及残石病例。术后住院时间4～7 d,平均为5 d。152例均获随访,随访时间为1～17个月,平均为8个月。经B超或MRCP证实,未发现有胆道狭窄及残石者。结论腹腔镜指导下纤维胆道镜胆总管探查术是安全、有效的方法,微创效果明显,如能在取净结石的情况下行胆总管一期缝合,微创效果尤为明显。

Clincal application of laparoscopic common bile duct exploration with fibercholedoscopy

Objective: To investigate the feasibility and implementation value of fibercholangioscopic bile duct exploration guided by laparoscopy.
Methods: All patients who had indications for bile duct exploration underwent laparoscopic common bile duct (CBD) exploration.After CBD incision was made laparoscopically, the cholangioscope was introduced into CBD for examination and treatment. Placement of T-tube or primary suturing of CBD was applied after exploration.
Results: Among the 152 patients who underwent CBD exploration, 141 patients had extrahepatic bile duct stone(s) which were all successfully extracted; and 11 patients were without bile duct stones (negative exploration). The time spent on cholangioscopic exploration and, or stone extraction was about 8 to 35 min (average 15 min). All 152 cases were operated successfully without conversion to open surgery. The CBD incision was sutured endoscopically after exploration in 42 patients, and the other 110 patients had T-tube drainge. The T-tubes were removed after a T-tube cholangiogram, done 3-4 weeks posoperatively, showed no residual stones. Two cases of bile leakage were discovered; however, there was no biliary stricture or residual stones in this series. Postoperative hospital stay of the patients was  4 to 7 days (average5 days). One hundred and fifty-two patients were followed up for 1 to 17 months (average 8 months)  with B-mode ultrasonography or MRCP examination,and no biliary tract stricture or residual stone was found in these patients.
Conclusions: Fibercholangioscopic bile duct exploration guided by laparoscopy is safe and reliable. Mini-trauma is more effective if primary suturing of the CBD can be done after the bile duct stones are totally extracted.