腹腔镜治疗胆总管下段巨大或嵌顿性结石的体会(附36例报告)  

Discussion the laparoscopic treatment of huge or impacted stones at distal common bile duct in 36 cases

作　　者：沈正海[1] 詹峰[1] 张楷[1] 蒋超[1] 张云[1] 

机构地区：[1]江苏大学附属宜兴医院,江苏宜兴214200

出　　处：《腹腔镜外科杂志》2014年第9期693-695,共3页Journal of Laparoscopic Surgery

摘　　要：目的:探讨胆总管下段巨大或嵌顿性结石腹腔镜术中处理方法及技巧。方法:回顾分析2009年9月至2013年9月为36例患者行腹腔镜胆总管探查术(laparoscopic common bile duct exploration,LCBDE)的临床资料。结果:术中采用导尿管注水加压冲刷配合分离钳、网篮成功取石6例;胆道镜直视下网篮及活检钳取石2例;常规取石钳配合网篮成功取石18例;钬激光配合网篮成功取石10例。手术时间平均(102±30.2)min,术中出血量平均(58.3±24.2)ml,术中未见胆总管损伤,术后胃肠道功能恢复时间平均(26.3±3.6)h,术后残余结石1例,并接受二次经T管窦道取石。术后随访6个月以上,未见胆管狭窄、胆管炎等并发症发生。结论:胆总管下段巨大或嵌顿性结石应根据术中具体情况采用个体化的取石方案,在保证手术安全的前提下,力争取尽结石。Objective： To explore the method and technique of laparoscopy in the treatment of huge or impacted stones at distal common bile duct. Methods： A retrospective analysis was made on the clinical data of 36 patients who underwent laparoscopic common bile duct exploration（ LCBDE） between Sep. 2009 and Sep. 2013. Results： Of the 36 patients,6 cases underwent pressurized washing through the common bile duct incision by urethral catheter combined with non-invasive clamp and stone basket. 2 cases underwent cholelithotomy with choledochoscopic basket together with biopsy forceps; 18 cases were performed cholelithotomy with bile duct routine operation instruments combined with stone basket; 10 cases underwent cholelithotomy with holmium laser and stone basket. The mean operation time was（ 102 ± 30. 2） min. The mean intraoperative blood loss was（ 58. 3 ± 24. 2） ml. There was no intraoperative bile duct injury. The time of postoperative gastrointestinal function recovery was（ 26. 3 ± 3. 6） h. Just 1 patient suffered from residual stones and received stone removal by choledochoscope through the sinus tract of the T tube. During following-up at least 6 months,there were no complications such as strictures of bile duct or cholangitis. Conclusions： The treatment of huge or impacted stones at distal common bile duct should be based on the specific circumstances and performed in individualized approach during LCBDE. Under the premise of ensuring safety of the surgery,the stones should be removed as much as possible.

关 键 词：胆总管结石 巨大或嵌顿结石 腹腔镜检查 病例报告 

分 类 号：R657.4[医药卫生—外科学]