开腹胆道术后腹腔镜再次胆道手术24例报告

目的：探讨开腹胆道术后腹腔镜再次胆道手术的手术方法、适应证和禁忌证。方法：采用腹腔镜胆囊切除术（LC）、腹腔镜胆总管探查术（LCDE）或腹腔镜球囊导管扩张术（LPBD）治疗开腹胆道术后腥道结石和胆管狭窄。结果：开腹胆囊切除术后腹腔镜再次胆管手术11例，成功9例，中转开腹2例。开腹胆囊切除及胆管探查术后腹腔镜再次胆管手术10例，成功7例，中转开腹3例。开腹胆囊造瘘术后LC及LCDE2例成功，开腹胆囊造痿胆总管T形管引流术后LC及LCDE1例成功。胆总管下端通畅程度：腹腔镜探查19例，不同程度Oddi括约肌狭窄17例均处理成功。无术中大出血，无肠道破裂；术后无胆漏，无肠痿，无腹腺炎；无死亡。手术时间90－310min,平均165min。结论：开腹胆道术后选择合适病例腹腔镜再次胆道手术治疗胆管结石和胆管狭窄具创伤小、有效、可行。

Laparoscopic Common Bile Duct Exploration after Opening Biliary Operation: Report of 24 Cases

Objective:To discuss the operative methods, indications and complications of laparoscopic common bile duct exploration after openning biliary operation selected multiple methods were combined to extract the bile duet stones and treat the bile duct stenosis. Method:Twenty-four patients (in which include interchangeable to open abdomen CBD exploration 5 cases) were admitted to have the procedures from August 1995 to January 2002, i .e. laparoscopic cholecystectomy (LC), laparoscopic common bile duct exploration (LCDE), laparoscopic papillary ballon dilation (LPBD),laparoscopic papillary ballon dilation endoprosthesis and stent (LPBDE or LPBDS ), laparoscopic papillary ballon dilation primary closure (LPBDP).Results:Ninteen patients had completed successful duct clearance in total 24 patients, interchangeable to open abdomen CBD exploration 5 cases. Seventeen patients had treated the bile duct stenosis in total 19 patients of LCDE.Conclusions:With the development of laparoscopic technique, combined the wide spread use of LPBD and LPBDE, the combined methods of the kind is practicable and safe in hands of sophisticated endoscopists.