腹腔镜、胆管镜同期治疗胆囊结石合并正常直径胆总管结石  

Combined laparoscopy and choledochoscopy in the treatment of cholecystolithiasis associated with "common caliber" choledochus stones

作　　者：郭鑫[1] 陈安平[2] 李波[1] 山长星[1] 索运生[2] 刘安[2] 易斌[2] 王征夏[2] 

机构地区：[1]遵义医学院成都附属医院肝胆外科,成都610017 [2]成都市第二人民医院肝胆外科

出　　处：《中华普外科手术学杂志（电子版）》2012年第1期42-45,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的总结运用腹腔镜、胆管镜同期治疗胆囊结石合并正常直径胆总管结石的临床经验。方法完成腹腔镜胆囊切除后,经胆囊管残端扩张、经胆囊管胆总管汇合部切开或经胆总管前壁切口入路,采用胆管镜取石网取石、液电碎石、经胆囊管残端输尿管导管胆管引流、T管引流或胆总管切口即时缝合等,有选择地对205例胆总管内径≤0.8cm的正常直径胆总管结石患者进行治疗。结果腹腔镜胆总管探查取石术205例中,腹腔镜联合术中胆管镜取尽结石162例,中转为术中十二指肠镜下乳头切开取石43例,无中转开腹。胆管镜组162例患者平均手术时间112min,术后并发症率5.5%(9/162),无残余结石;十二指肠镜组43例患者平均手术时间95min。术后并发症率9.3%(4/43),术后残余结石1例。无肠穿孔、胆管穿孔、大出血、重症胰腺炎等并发症,无死亡。结论只要选择合适的病例,腹腔镜、胆管镜同期联合手术治疗胆囊结石合并正常直径胆总管结石是可行、有效和安全的。Objective To summarize the experience with combined choledochoscopy and laparoscopy in the treatment of cholecystolithiasis associated with ＂ common caliber＂ choledoehus stones. Methods From October 1993 to November 2010, we treated 205 patients with choMithiasis in thin cboledochus with a common bile duct diameter equal to 0.4 - 0. 8 cm using laparoscopic cholecystectomy, including choledochotomy, choledochoscopic exploration, electrohydralic lithothipsy, implant of ureteral catheter through cystic duct remnant for the drainage of the bile duct, T-tube drainage, and the primary closure of duct incision. Results Choledochoscopy in this series took an average of 112 minutes and postoperative complications occurred in 5. 5% of the patients, but residual stones were not found. Duodenoscopy in 43 patients took an average of 95 minutes and postoperative complications were noted in 9.3% of the patients. One patient however suffered from residual stones, but demonstrated no intestinal perforation, bile duct perforation, bleeding, severe pancreatitis and other complications. Conclusions Combined use of laparoscopy and choledochoscopy is safe and effective to treat cholecystolithiasis associated with small choledochus stones.

关 键 词：腹腔镜检查 胆总管结石 胆囊结石病 括约肌切开术 内窥镜 

分 类 号：R657.4[医药卫生—外科学]