应用纤维胆道镜经胆囊管入路治疗胆总管结石  

COMMON BILE DUCT CALCULI WERE EXTRACTED THROUGH CYSTIC DUCT WITH FIBERCHOLANGIOSCOPY

作　　者：尚培中[1] 贾国洪[1] 崔丽[1] 李永庆[1] 苗建军[1] 李晓武[1] 朱习琴[1] 李霞[1] 

机构地区：[1]解放军第251医院全军消化道疾病微创治疗中心,张家口075000

出　　处：《肝胆外科杂志》2009年第1期43-45,共3页Journal of Hepatobiliary Surgery

摘　　要：目的探讨腹腔镜胆囊切除(LC)术中应用纤维胆道镜经胆囊管入路治疗胆总管结石的效果及临床意义。方法采用OlympusCHFP20胆道镜,经胆囊管入路施行胆管探查取石术76例,其中直接置入胆道镜36例;经胆囊管胆总管汇合处切开胆总管侧壁置入胆道镜40例。结果①直接置入胆道镜者,取石后闭合胆囊管残端29例,置放胆囊管导管7例。取净结石34例,残留结石2例,术后经内镜十二指肠乳头肝胰壶腹括约肌切开(EST)取石成功;②经胆囊管胆总管汇合处切开胆总管侧壁置入胆道镜者,取净结石37例,推入十二指肠2例,胆管切口出血中转开腹1例。一期缝合不放置引流管12例,术后胆漏1例,引流1周愈合;应用胆囊管导管预防胆漏27例,术后7～24天拨管出院。随访1个月～2年无异常。结论LC术中应用纤维胆道镜经胆囊管入路施行胆管探查取石,创伤小,痛苦轻,恢复快,是目前较理想的微创治疗方法;对胆囊管细小者,在胆囊管胆总管汇合处切开胆总管侧壁可扩大手术适应证。选择性放置胆囊管导管,有利于引流感染性胆汁,减轻胆道压力及胆管壁水肿,保障切开的胆囊管及胆总管顺利愈合。Objective To evaluate the clinical results and significance of transcystic common bile duct （CBD） exploration and fibercholangioscopic extraction of complicated choledocholithiasis during laparoscopic cholecystectomy. Method Laparoscopic transcystic CBD exploration were performed with fibercholangioscopy （ Olympus CHF P20） for 76 patients with cholecystic and CBD calculi. CBD calculi were extracted through cystic duct directly in 36 cases and thorough incision the union of the cystic duct and CBD indirectly in 40 cases. Results ①Thorough cystic duct directly：Stump of cystic duct was ligated in 29 cases. A cystic duct tube was inserted into CBD thorough cystic duct following clearance of calculi in 7 cases. CBD calculi were successfully extracted in 34 cases. Residual calculi were taken out thorough endoscopic sphincterotomy （EST） in 2 cases. ②CBD calculi were successfully extracted thorough incision the union of the cystic duct and CBD in 37 cases, and pushed through Oddi sphincter in 2 cases. Laparotomy was undergone in one patient due to hemorrhage. Primary closure of the union and stump was performed for 12 cases with postoperative bile leakage cured within one week in 1 cases. Twenty-seven patients were underwent cystic duct tube drainage to prevent postoperative bile leakage. The hospital stay was 7 to 24 days. Follow-up checkup for 1 - 24 months found no residual calculi. Conclusions CBD calculi were extracted by fibercholangioscopy thorough cystic duct during laparoscopic cholecystectomy has some advantages, such as minor damage, less suffering and rapid recovery, and is a better minimally invasive treatment for cholecystolithiasis and complicated choledocholithiasis. Operative indication may be extended for the thin cystic duct by incising the union of the cystic duct and CBD. Cystic duct tube drainage for some patients with septic biliary juice could help to reduce the pressure of oedematous biliary tract and heal the incision of the union of the cystic duct and CBD.

关 键 词：胆囊结石病 胆总管结石病 腹腔镜检查 纤维胆道镜检查 胆总管探查取石术 

分 类 号：R657.4[医药卫生—外科学]