腹腔镜下胆道镜胆总管探查取石135例临床应用  

Laparoscopic common bile duct exploration for cholecystolithiasis complicated with choledocholithiasis:a clinical analysis of 135 patients

作　　者：王湘辉[1] 上官建营[1] 项红军[1] 袁克文[1] 肖毅[1] 张超[1] 

机构地区：[1]兰州军区兰州总医院肝胆外科,甘肃兰州730050

出　　处：《西北国防医学杂志》2014年第6期514-517,共4页Medical Journal of National Defending Forces in Northwest China

摘　　要：目的：总结腹腔镜联合纤维胆道镜治疗胆囊结石合并胆总管结石的临床疗效。方法：回顾性总结我科2011-07-2013-12收治的135例胆囊结石合并胆总管结石患者经腹腔镜联合纤维胆道镜取石的＂一步＂微创治疗临床资料。结果：135例患者均安全出院,无围手术期死亡;中转开腹率5.2%（7/135）。128例腹腔镜下顺利完成胆道镜探查胆总管取石术,平均手术时间115min,术中平均出血量120ml,其中13例（10.2%）经胆囊管完成胆道镜探查胆总管取石,115例（89.8%）经胆总管切开完成手术。术后主要并发症：胆漏,均为一过性,发生率为8.6%（11/128）,经腹腔引流管引流痊愈;结石残余,发生率为7.0%（9/128）,均采用胆道镜经窦道成功取出;另有2例术后发生急性肾功能衰竭,经连续性肾脏替代治疗（CRRT）等治愈;1例胆道出血,经保守治疗治愈;1例Oddi括约肌狭窄,经内镜括约肌切开（EST）治愈。结论：对于胆囊结石合并胆总管结石的患者,采用腹腔镜联合术中胆道镜取石,可以＂一步＂解决胆囊和胆管结石,充分发挥微创外科安全、有效、恢复快的优势。Objective：To summarize the clinical efficacy of laparoscopic common bile duct exploration for the treatment of cholecystolithiasis complicated with choledocholithiasis. Methods： Clinical data of 135 patients with cholecystolithiasis complicated with choledocholithiasis admitted from July 2011 to December 2013 were studied retrospectively. All patients received a single-stage management for the gallstone and ductal calculi. Results： All patients were recovered from the surgical procedures. Seven patients were converted to laparotomy. Laparoscopic common bile duct exploration was carried out successfully for 128 patients. The average operative time was 115 minutes and the average blood loss was 120 ml. Among these patients,13 cases （10. 2%） received transcystic common bile duct exploration and the others underwent laparoscopic choledocholithotomy. The major postoperative complications were bile leakage in 11 patients and residue calculus in 9. Other complications included acute kidney failure in 2 patients, hemobilia in one and stenosis of Oddi sphincter in another. All of the patients with these complications recovered after appropriate treatment. Conclusion： Single- stage management of the gallstone disease and ductal calculi With laparoscopic common bile duct exploration for patients with cholecystolithiasis complicated with choledocholithiasis is safe and effective,with quick recovery.

关 键 词：胆结石 腹腔镜 胆总管探查术 胆道镜 

分 类 号：R657.42[医药卫生—外科学]