胆总管结石的微创处理策略选择  

Strategy choice of minimally invasive treatment for patients with common bile duct calculi

作　　者：吴国忠[1] 莫晓东[1] 陆春雷[1] 芮小平[1] 葛继强[1] 李会斌[1] 

机构地区：[1]解放军第101医院,江苏无锡214044

出　　处：《腹腔镜外科杂志》2009年第1期65-66,共2页Journal of Laparoscopic Surgery

摘　　要：目的:探讨合理选择胆总管结石患者的手术方法及时机。方法:总结我院1992年至2008年3月开展腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)20000余例的经验,尤其是971例患者合并胆总管结石的治疗经验。结果:LC术前行内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)发现胆总管结石246例,其中230例顺利完成内镜十二指肠乳头括约肌切开取石术的患者在完成LC后发现胆总管残留结石15例,经过再次内镜手术取出结石。LC术后残留结石73例中68例完成内镜乳头括约肌切开取石术(endoscopic sphincterotomy,EST),5例再次开腹手术。完成491例腹腔镜胆总管切开纤维胆道镜取石,"T"管引流术(laparoscopic choledocholithotomy T-tube drainage,LCTD),出现胆漏11例,经保守治疗治愈。173例经过胆囊管取出胆总管结石,无并发症发生。结论:LCTD是治疗胆总管结石较理想的微创术式,可通过切开胆囊管和部分胆总管,减低手术难度,缩短手术时间。EST手术应在LC前,以免LC后行EST失败,需再次行开腹手术。Objective：To explore the choice of reasonable operation method and opportunity in treatment of patients with bile duct calculi. Methods： A retrospective analysis was made on clinical data of 20 000 cases of gallbladder calculi treated by laparoscopic cholecystectomy from 1992 to Mar. 2008 in our hospital, especially 971 cases with common b^le duct calculi. Results：Two hundred and forty-six patients underwent endoscopic retrograde cholangiopancreatography （ERCP） before laparoscopic eholecystectomy. 230 cases were treated successfully by endoscopic sphincterotomy（EST） , and then calculi were found in 15 cases and removed successfully by endoscopy. Residual stones were found in 73 cases after LC, and 68 cases were treated successfully by EST,5 cases were treated by open surgery. Laparoscopic choledocholithotomy T-tube drainage （LCTD） was performed in 491 cases, all 11 cases of bile leakage were cured conservatively. 173 cases were treated by transcystic duct exploration, and were cured conservatively, 173 cases were treated by transcystic common bile duct exploration, and there were no complications. Conclusions：LCTD can be performed with high efficiency, minimal morbidity,it is a good method in treatment of patients with common bile duct calculi. In order to avoid laparotomy, EST should be performed before LC.

关 键 词：胆总管结石 腹腔镜术 内窥镜检查 

分 类 号：R657.42[医药卫生—外科学]