胆囊管汇入部微切开在腹腔镜胆道探查术中的应用  

Transcystic Approach with Micro-incision of the Cystic Duct and its Confluence Part in Laparoscopic Common Bile Duct Exploration

作　　者：韩威[1] 张忠涛[1] 李建设[1] 金岚[1] 刘军[1] 赵晓牧[1] 郭伟[1] 王宇[1] 

机构地区：[1]首都医科大学附属北京友谊医院普外科,北京100050

出　　处：《中国微创外科杂志》2011年第11期970-972,共3页Chinese Journal of Minimally Invasive Surgery

基　　金：北京市优秀人才培养资助基金(编号:PYZZ090416001576)

摘　　要：目的探讨经胆囊管汇入部微切开技术在腹腔镜胆道探查术中的应用价值。方法 2006年12月～2010年12月,对34例经胆囊管取石困难、24例经胆囊管进入胆道镜困难者,采用经胆囊管汇入部微切开技术完成腹腔镜胆道探查术。沿胆囊管汇入胆总管处微切开3～5 mm,完成胆道镜经胆囊管胆道探查取石后,再将胆囊管成形缝合并夹闭。结果手术均获成功,手术时间(98.1±38.1)min,术后住院日(2.8±1.9)d,胆囊管残端漏2例,无严重并发症发生。56例平均随访时间29.6月(3～51个月),无胆道狭窄,1例术后1年结扎夹游走进入胆总管,再次腹腔镜手术。结论合理选择适应证的情况下,经胆囊管汇入部微切开技术在腹腔镜胆道探查术中安全可行,可提高腹腔镜经胆囊管胆道探查术的成功率。Objective To study the value of trans-cystic approach with micro-incision of the cystic duct and its confluence part in laparoscopic common bile duct exploration.Methods Between December 2006 and December 2010,we performed micro-incision of the cystic duct and its confluence part in 58 cases（24 cases had difficulty with trans-cystic approach,and 34 cases were difficult for retrieval stones from the cystic duct） during laparoscopic trans-cystic common bile duct exploration.Along its confluence part,the cystic duct was cut 3-5 mm so that to carry out trans-cystic common bile duct exploration;and then the cystic duct was sutured and clipped to close the bile duct.Results The mean operation time and postoperative hospital stay were（98.1±38.1） minutes and（2.8±1.9） days,respectively.No severe procedure-related complication occurred,but bile leak from the cystic duct in 2 cases,who was then cured with drainage.56 cases were followed up for a mean of 29.6 months（3-51 months）,during which no biliary tract stricture was observed;clip migration into the common bile duct happened in 1 case,who received re-exploration of the common bile duct by laparoscopy in 1 year post-operation.Conclusions With selected indications,micro-incision of the cystic duct and its confluence part is safe and feasible.This procedure can improve the success rate of transdystic common bile duct exploration under laparoscope.

关 键 词：腹腔镜 胆道镜 经胆囊管 胆囊管汇入部 微切开 胆道探查术 

分 类 号：R657.4[医药卫生—外科学]