腹腔镜手术中胆囊管结石的处理策略  

The strategy of laparoscopic surgery and diagnosis in the treatment of cystic duct stones

作　　者：顾澄宇[1] 陈颖[1] 乔谦[1] 徐成凯[1] 毕杰[1] 蔡兵[1] 

机构地区：[1]南京医科大学附属无锡市人民医院肝胆外科,江苏省214023

出　　处：《江苏医药》2015年第10期1177-1179,共3页Jiangsu Medical Journal

基　　金：无锡市医院管理中心肝胆胰结对发展专科基金

摘　　要：目的探讨腹腔镜手术中胆囊管结石的诊断与处理。方法回顾性分析78例胆囊管结石患者行腹腔镜手术的临床资料。结果术前B超诊断胆囊管结石的准确率为25.6%(20/78),CT为30.8%(24/78),磁共振胰胆管成像(MRCP)为81.5%(53/65)。78例腹腔镜手术均获成功。其中,7例合并胆总管结石患者行腹腔镜胆囊切除胆总管切开探查取石术(LCBDE),8例高危老年患者先行经皮经肝胆囊穿刺引流术(PTGBD),1个月后再行腹腔镜胆囊切除术(LC)。术后并发穿刺孔感染1例,胆漏1例。术后随访8个月-2年未发生胆道狭窄及胆总管结石。结论胆囊管结石术前诊断较为困难,MRCP有助于发现胆囊管结石,高危老年患者应先行PTGBD,尽可能避免急诊手术。疑有胆囊管结石应仔细探查胆囊管,腹腔镜手术处理胆囊管结石安全可行。Objective To summarize the experience in the diagnosis and laparoscopic surgery for cystic duct stones. Methods Data of 78 cases with calculus in cystic duct performed laparoscopic cholecystectomy or common bile duct exploration were analyzed retrospectively. Results The accuracy rates of B-ultrasound,CT and magnetic resonance cholangiography（MRCP） for preoperative diagnosis of cystic duct stones were 25.6% （20/78）, 30. 8% （24/78） and 81.5% （53/65）, respectively. The surgeries were all successfully performed with laparoscopy in all cases, of whom laparoscopic common bile duct exploration was performed in 7 cases, and percutaneous transhepatic gallbladder drainage （PTGBD） at first and LC were applied 30 days later in 8 high-risk elderly patients. Puncture infection occurred in one case and bile leakage in another case after operation. The patients were followed up from 8 months to 2 years, which showed no biliary stricture and bile duct stones. Conclusion Preoperative diagnosis of cystic duct stones is difficult and MRCP is recommended to identify the cystic duct stones. PTGBD should be done at first in high-risk elderly patients. Cystic duct should be carefully explored when cystic duct stones were suspected during the operation. Laparoscopic surgery for calculus of cystic duct is feasible and safe.

关 键 词：胆囊管结石 腹腔镜手术 

分 类 号：R657[医药卫生—外科学]