腹腔镜联合胆道镜治疗胆道结石18例临床分析  

Laparoscopy combined with choledochoscopy in treatment of bile duct calculi in 18 cases

作　　者：阿不都外力[1] 阿布都克尤木吾甫尔 史生伟[1] 

机构地区：[1]沙湾县人民医院,新疆塔城832100 [2]喀什地区第一人民医院

出　　处：《腹腔镜外科杂志》2014年第8期587-589,共3页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜胆囊切除(laparoscopic cholecystectomy,LC)联合腹腔镜胆总管探查取石术(laparoscopic common bile duct exploration,LCBDE)治疗胆囊结石、胆道结石患者的临床疗效。方法:回顾分析2011年1月至2013年5月为18例患者行LC联合LCBDE的临床资料。结果:17例顺利完成手术,1例因放置T管困难,中转开腹,术中发现胰头明显增大,质韧,取组织送快速冰冻检查,结果为良性增生,行胆肠内引流术。手术时间平均(138±45)min,术中出血量平均(28±11)ml,平均住院(6.7±0.8)d,术后胃肠功能恢复时间平均(21±6)h,术后下床时间平均(14±3)h,17例平均随访(8.0±3.2)个月,患者恢复良好,未发生胆总管残留结石、胆总管狭窄、胆漏等并发症。结论:腹腔镜联合胆道镜治疗胆道结石具有明显的微创优势,是安全、有效的,保证了Oddi括约肌功能的完整性,术后并发症减少,住院时间短,患者康复快,适于基层医院开展。Objective：To discuss the clinical efficacy of laparoscopic cholecystectomy （LC） combined with laparoscopic common bile duct exploration （LCBDE） in treatment of gallstone and bile duct calculi. Methods：The clinical data of 18 patients underwent LC plus LCBDE from Jan. 2011 to May 2013 were analyzed retrospectively. Results：The operations were successful in 17 cases. One case was converted to laparotomy because it was difficult in inserting T tube, and the head of pancreas was found enlarged obviously and tough, which was proved benign hyperplasia by frozen section, and finally underwent biliary enterostomy. The average operation time was （138 ±45 ） rain, the average intraoperative bleeding was （28 ± 11 ） ml, the average hospital stay was （6.7 ± 0.8 ） d, the average post- operative gastrointestinal function recovery time was （21 ± 6） h, the average ambulation time was （ 14 ±3） h. After average （ 8.0 ± 3.2） months of follow-up for 17 patients, they recovered well without any complications such as residual common bile duct stones, common bile duct stenosis or biliary leakage. Conclusions ： The treatment of bile duct calculi by laparoscopy combined with choledochoscopy has the obvious advantage of minor invasion. It is safe and effective, and can keep the integrity of Oddi sphincter function. It has less postoperative complications, shorter hospital stay, faster recovery and it is suitable for primary hospital.

关 键 词：胆囊结石病 胆道结石 腹腔镜检查 胆道镜检查 病例报告 

分 类 号：R657.4[医药卫生—外科学]