腹腔镜胆系手术避免胆管损伤的探讨(附8240例报道)  

Approach of laparoscopic cholecystectomy avoiding bile ducts injury(8240 cases)

作　　者：邵明远[1] 王泓[1] 蒋波[2] 郭和[2] 李冬生[2] 

机构地区：[1]四川省科学城医院,四川绵阳621900 [2]四川省凉山州中西医结合医院,西昌615000

出　　处：《重庆医学》2010年第12期1557-1558,共2页Chongqing medicine

摘　　要：目的探讨腹腔镜胆囊切除和经纤维胆道镜肝内、外胆管取石和液电碎石操作中避免胆管损伤的技巧和方法。方法常规腹腔镜操作流程。术中纤维胆道镜经扩张后的胆囊管残端探查肝内、外胆管,套取结石和液电碎石后取石,对于复杂、广泛的肝内、外胆管结石,纤维胆道镜经肝胆总管切开操作。结果 8240例中腹腔镜下经纤维胆道镜治疗肝内、外胆管结石720例、胆管损伤4例(占全组的0.49‰)、术中转开腹37例(占全组的4.49‰),全组无死亡病例。术后随访5250例,随访6个月至5年,效果良好,无近、远期后遗症。结论腹腔镜和腹腔镜下纤维胆道镜治疗胆系结石是行之有效的方法。腹腔镜手术医生的素质、临床经验、专业技术和手术技巧是避免胆管损伤的关键所在。Objective To discuss the techniques and methods in which bile ducts injury can be avoided during the procedure of removing the calculus and electrohydraulic lithotripsy by laparoscopic cholecystectomy （LC） and fibercholedochoscope through the intrahepatic and extrahepatic bile ducts.Methods Regular laparoscopic procedure.During the operation,using the fibercholedochoscope to search the intrahepatic and extrahepatic bile ducts via dilated cystic duct residue,then removing the calculus after extracting the calculus and electrohydraulic lithotripsy; the cutting operation used choledochofiberscope via hepatocholedchus for the complex and extensive intrahepatic and outhepatic bile duct stones.Results Among 8 240 cases,720 cases with intrahepatic and outhepatic bile duct stones were cured by choledochofiberscope under the laparoscope,and 4 cases with bile duct injured （0.49‰）,and 37cases were instead of ventrotomy（4.49‰）and nobody died。After the operation,5250 cases were follow-up visited for the span from six months to five years,with the satisfactory effect and none short and long term sequela.Conclusion laparoscope and choledochofiberscope are the effective method for intrahepatic and outhepatic bile duct stones。The quality and clinical experences and technology and techniques of the laparoscope operator is the key.

关 键 词：胆管 腹腔镜 纤维胆道镜 

分 类 号：R657.42[医药卫生—外科学] R616.6[医药卫生—临床医学]