腹腔镜经胆囊管开口取石并内支架引流治疗胆囊结石合并胆总管结石

目的:探讨腹腔镜胆囊切除及经胆囊管开口取石并内支架引流术的可行性及临床疗效。方法:2008年1月至2013年1月为28例胆囊结石合并胆总管结石患者行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)及经胆囊管开口胆管探查取石,内支架引流管引流并一期缝合胆管术。总结其适应证、操作技术及临床疗效。结果:28例均成功完成LC及经胆囊管开口取石并内支架引流术。胆管内取出单一结石19例,2~4枚结石9例。手术时间平均(43.6±19.8)min,平均住院(7.9±3.5)d。26例支架自行脱落并顺利排出体外;2例未自行排出的患者,于1个月后经十二指肠镜行胆道支架取出。未发生胆管结石残留、胆管狭窄、胆漏等手术并发症。结论:LC及腹腔镜经胆囊管开口取石并内支架引流术具有手术时间短、术式简单、术后并发症少等特点,在严格掌握适应证、选择合适病例的情况下,此术式安全、有效、可行。

Laparoscopic transcystic common bile duct exploration and biliary stent drainage in the treatment of gallbladder and common bile duct stones

Objective： To explore the feasibility and clinical effectiveness of laparoscopic cholecystectomy,laparoscopic transcystic common bile duct exploration and biliary stent drainage. Methods： From Jan. 2008 to Jan. 2013,28 patients of gallbladder and common bile duct stones were treated by laparoscopic cholecystectomy,laparoscopic transcystic common bile duct exploration,biliary stent drainage and primary suture of bile duct. The indications,operation techniques and clinical efficacy of this procedure were reviewed. Results： The procedure was accomplished in all 28 patients without residual stones,biliary stricture or bile leakage. There were1 bile duct stone in 19 patients,and 2 to 4 bile duct stones in 9 patients. The operation time was（ 43. 6 ± 19. 8） min and the hospital stay was（ 7. 9 ± 3. 5） d. The stents set in the common bile duct spontaneously passed through the duodenum in 26 cases,and the remaining 2 stents were removed by duodenoscope 1 month after the operation. No symptoms were complained in any patients while stenting.Conclusions： It is feasible to perform laparoscopic transcystic common bile duct exploration,stone removal and biliary stent drainage for the patients of cholecystolithiasis combined with choledocholithiasis. Compared with other minimally invasive procedures,the advantages include short operating time,easy manipulation and few complications. It is safe,simple,efficacious,feasible and well-tolerated for strictly chosen patients,and is worthy of popularization and application.