小切口手术联合胆道镜治疗胆石症  

MANAGEMENT OF CHOLELITHIASIS BY SURGICAL OPERATION WITH SMALL INCISION AND CHOLEDOCHOSCOPY

作　　者：高之阳[1] 高瞰非[1] 吴舟锋[1] 胡月明[1] 廖武军[1] 

机构地区：[1]杭州市萧山区第一人民医院,杭州311201

出　　处：《肝胆外科杂志》2005年第4期289-291,共3页Journal of Hepatobiliary Surgery

摘　　要：目的总结小切口手术联合胆道镜治疗胆石症的经验.方法回顾分析1995年1月至2004年4月以小切口联合胆道镜手术治疗1367例胆石症的临床资料.胆道镜处理有3种途径:经胆囊管途径(297例),经胆总管切开途径(327例)和经术后T管窦道途径(305例).结果1367例中在小切口(3～5cm)下完成手术者1320例,47例(3.4%)因出血、粘连、解剖变异或胆道损伤等各种原因将切口延长至5cm以上始完成手术.743例为单纯胆囊切除.624例联合胆道镜处理,其中150例未发现胆总管结石,474例发现胆总管结石,467例经术中术后胆道镜取尽,7例胆总管结石紧嵌于胆总管末端,术后以EST(4例)和气压弹道碎石后取尽(3例).发生术后并发症31例.结论小切口联合胆道镜手术是一种相对微创的直视下治疗胆石症的便捷方法.Objective To summarize the treatment experiences for cholelithiasis by surgical operation with small incision and choledochoscopy. Methods During Jan. 1995～Apr. 2004, 1367 patients with cholelithiasis were treated by operation their data were analyzed retrospectively. There were three types of choledochoscopic exploration： Ⅰ. 297 cases bycyst-duct Ⅱ . 327 cases by choledocholithotomy Ⅲ . 305 cases by T-tube sinus tract. Result The surgical operation on 1320 cases out of total 1367 cases was performed at a small incision ranged 3-5cm. The other 47（3.4% ） cases were finished under a lenfthenedincision （〉5cm） because of various problems such as bleeding , adhesion or injury of bile duct etc. The simple cholecystectomy for 743 cases was performed. The choledochoscopic management for 624 cases was practiced . Stone in extrahepatic duct of 467 cases out of 474 cases found during the operation was successfully removed by choledochoscopy. Remained 7 cases stones were removed using assistant measures including EST and lithotrity. The significant complications occunned in thirty one cases. Conclusion The surgical operation at a small incision and choledochoscopy is a directive ,convenient and relatively microinvasive method treating cholelithiasis.

关 键 词：外科手术 小切口 胆石症 胆道镜 

分 类 号：R575.62[医药卫生—消化系统]