急诊腹腔镜手术治疗胆总管结石合并轻、中度急性胆管炎的疗效  

Efficacy of laparoscopic common bile duct exploration combined with laparoscopic cholecystectomy for treatment of common bile duct stones with mild to moderate acute cholangitis

作　　者：李颖[1,2] 朱斌[1,2] 李丹[1,2] 任宇[1,2] 王岩[1,2] 宫轲[1,2] 路夷平[1,2] 阿民布和[1,2] 张能维[1,2] 

机构地区：[1]北京大学第九临床医学院 [2]首都医科大学附属北京世纪坛医院普通外科,北京市100038

出　　处：《世界华人消化杂志》2015年第22期3614-3619,共6页World Chinese Journal of Digestology

摘　　要：目的:探讨腹腔镜胆总管探查取石术(common bile duct exploration,CBDE)联合胆囊切除术(laparoscopic cholecystectomy,LC)治疗胆总管结石(common bile duct stones,C B D S)合并轻、中度急性胆管炎的安全性及有效性.方法:对2009-01/2012-12收治的37例胆囊结石伴CBDS合并轻、中度急性胆管炎患者行腹腔镜CBDE联合LC.除外有重度急性胆管炎、上腹部手术史、严重心肺及其他影响全麻或手术等疾病的患者.常规四孔法完成经胆总管切开的腹腔镜CBDE、T管引流及LC.根据术前MRCP了解结石大小、数量和位置,用推挤、冲吸及胆道镜等方法取石,病情不稳定者,不行术中胆道镜取石.所有患者均不行术中胆道造影.Winslow孔处常规放置腹腔引流管.有胆道残余结石者,术后8 wk行胆道镜取石.结果:37例胆囊结石伴CBDS合并轻、中度急性胆管炎患者,均顺利完成腹腔镜CBDE及LC.手术时间105.54 min±6.30 min;胆总管直径12.86 mm±0.58 mm;单发CBDS 14例(37.8%),多发CBDS 23例(62.2%);术后胆囊病理结果,急性胆囊炎9例(24.32%),慢性胆囊炎28例(75.68%);术后住院天数为11.27 d±0.82 d;总住院天数16.41 d±1.03 d.腹腔镜CBDE术后胆管炎症状及体征明显缓解,实验室检查结果改善.无中转开腹、术后腹腔出血、胆道损伤、手术死亡及伤口感染.术后胆漏4例,经保守治疗治愈.术后胆道残余结石4例,术后经T管窦道胆道镜取净结石.结论:对部分CBDS合并轻、中度急性胆管炎患者,腹腔镜CBDE及LC治疗是安全、有效及可行的.AIM：To evaluate the outcomes of laparoscopic common bile duct exploration（CBDE）combined with laparoscopic cholecystectomy（LC） for treatment of common bile duct stones（CBDS） with mild to moderate acute cholangitis.METHODS：A retrospective clinical study was performed from January 2009 to December2012.A total of 37 patients underwent laparoscopic CBDE with T-tube drainage and laparoscopic cholecystectomy（LC） for CBDS with mild to moderate acute cholangitis and gallbladder stones.Patients with severe cardiopulmonary co-morbidities were excluded.During laparoscopic CBDE,the relationship of the cystic duct to the CBD and common hepatic duct was clearly identified.Choledochoscopy and stones retrieval were not necessary in order to shorten operation time and to lower danger of the surgical procedure during laparoscopic CBDE.A drain was left at foramen of Winslow.Postoperative cholangiograms and/ or choledochoscopy were accomplished in all the patients before T-tube removal,and retained stones were removed.RESULTS：Laparoscopic CBDE and LC procedure was successful in all the 37 patients.Duration of the procedure was 105.54 min ± 6.30 min.The mean diameter of the common bile duct was 12.86 mm ± 0.58 mm.There were 14（37.8%） cases of solitary and 23（62.2%） cases of multiple CBDS,and 9（24.32%） cases of acute and 28（75.68%） cases of chronic cholecystitis.Posto perative hospital stay and whole hospital stay were 11.27 d ± 0.82 d and 16.41 d ± 1.03 d,respectively.Control of septic symptoms and improvement of laboratory data were postoperatively achieved in all patients.There was no conversion to open common bile duct exploration,no major bile duct injuries and no mortality in this study.Overall,4 cases of bile leak and 4 cases of retained stones were discovered.Bile leak was postoperatively cured by conservative therapy with a drain left,and the retained stones were retrieved postoperatively by choledochoscopy.CONCLUSION：Laparoscopic CBDE with T-tube drainage and LC for the treatment of

关 键 词：胆总管结石 腹腔镜胆总管探查取石术 急性胆管炎 

分 类 号：R657.4[医药卫生—外科学]