基层医院开展腹腔镜联合胆道镜胆道探查取石术思考  

Thought of Basic Hospital Laparoscopic Bile Duct Exploration Joint Choledochoscope Lithotomy

作　　者：赖景奎 刘兴东[1] 曾鹏[1] 杨波[1] 刘洪[1] 

机构地区：[1]彭州市人民医院,四川彭州611930

出　　处：《四川医学》2015年第12期1698-1700,共3页Sichuan Medical Journal

摘　　要：目的探讨基层医院开展腹腔镜联合胆道镜胆道探查取石术手术入路、操作性及安全性。方法回顾性研究23例患者的临床资料,总结手术入路方式、手术方式、手术时间、住院时间、手术并发症、手术成功率及残石率。结果术前患者通过彩色B超和/或CT、MRCP检查诊断胆总管结石或肝内胆管结石,术中行腹腔镜胆囊切除、胆道探查术,患者手术时间为1~3.5h。其中经胆总管探查取石20例,胆囊颈管探查3例,放置T管17例,1期缝合3例,胆囊颈管结扎3例;术中取出结石数目〉6枚者5例,3~6枚者6例,3枚以下者12例;结石直径为0.5~1.2 cm;住院时间5~14 d。术后无胆瘘及腹膜炎等并发症出现,胆总管残余结石2例1例通过EST取石成功,1例通过T管取石成功。结论根据患者的情况选择不同的手术入路及手术方式,腹腔镜胆道探查术治疗胆囊结石合并胆总管结石是安全可行的,但是基层医院仍需要沿学习曲线加强学习。Objective Discussion on basic hospital laparoscopic bile duct exploration joint choledochoscope lithotripsy surgical approach,maneuverability and safety. Methods A retrospective study of 23 patients,the surgical approach way of summary,surgical approach,operative time,hospital stay,complications and surgical success rate and residual stone rate. Results Color B by preoperative ultrasound and / or CT,MRCP diagnosis of choledocholithiasis or intrahepatic bile duct stones,intraoperative laparoscopic cholecystectomy,bile duct exploration surgery,patients operative time was 1 ~ 3. 5 h. Which by common bile duct exploration in 20 cases,3 cases of cystic neck exploration,T tube placed 17 cases,a suture in 3 cases,3 cases of cystic duct ligation neck,the number of stone removal surgery 65 cases,3 to 6 pieces were six cases,three of the following 12 cases. Stone diameter 0. 5 ~ 1. 2cm. Hospitalization time 5 ~ 14 d. No postoperative biliary fistula and peritonitis complications,bile duct residual stones two cases one case by EST stone success,one case of pipe stone success through T tube. Conclusion Select a different surgical approach and procedure according to the situation of the patient,the treatment of laparoscopic bile duct exploration cholecystolithiasis choledocholithiasis is feasible and safe,but the primary hospital still needs to enhance learning along the learning curve.

关 键 词：胆总管结石 腹腔镜检查 胆道镜 手术 

分 类 号：R657.42[医药卫生—外科学]