腹腔镜残余胆囊切除联合胆总管取石的临床运用  

Clinical Application of Laparoscopic Residual Cholecystectomy and Laparoscopic Common Bile Duct Exploration

作　　者：李毅[1] LI Yi(Department of Hepatobiliary and Pancreatic Surgery,Deyang City People's Hospital,Deyang Sichuan 618000,China)

机构地区：[1]四川省德阳市人民医院肝胆胰外科,四川德阳618000

出　　处：《中国继续医学教育》2018年第36期46-49,共4页China Continuing Medical Education

摘　　要：目的探讨腹腔镜下残余胆囊切除联合胆总管切开取石的可行性和安全性。方法 2012年3月—2018年5月,共对37例既往有胆囊或胆道手术史的患者行腹腔镜残余胆囊切除+胆总管切开取石术。术中常规采用三孔法腹腔镜分离粘连后暴露胆囊管、胆总管,行残余胆囊切除+胆总管切开,胆道镜取石术,记录手术资料,分析手术时间,术中出血量,术后并发症等。结果 37例患者均获得成功,平均手术时间(94.4±11.4)min;平均术中出血量为(7.6±0.6)ml;术后引流2～7 d,平均(4.0±1.2)d,术后住院时间4～12 d,平均(6.0±2.1)d。术后4周行经T管窦道胆道镜检查,取出残余结石并胆道冲洗后拔除T管。结论腹腔镜下残余胆囊切除+胆总管切开取石具有可行性和安全性。Objective To explore the feasibility and safety of laparoscopic residual cholecystectomy and laparoscopic common bile duct exploration. Methods From March 2012 to May 2018, 37 cases of patients with a history of gallbladder or biliary tract surgery were underwent laparoscopic residual cholecystectomy and laparoscopic common bile duct exploration. Three-hole laparoscopy was used to expose the cystic duct and common bile duct after laparoscopic separation of adhesion. Residual cholecystectomy plus choledochotomy and choledochoscopic lithotripsy were performed. The operation data were recorded and the operation time, intraoperative bleeding volume and postoperative complications were analyzed. Results 37 patients were successful, the average operation time was(94.4±11.4) minutes, and the average intraoperative bleeding volume was(7.6±0.6) ml. Postoperative drainage for 2 ~ 7 days, the average drainage time was(4.0±1.2) days after operation, and postoperative hospital stay 4 ~ 12 days, the average hospital stay was(6.0±2.1) days after operation. 4 weeks after operation, T-tube sinus cholangioscopy was performed, residual stones were removed, and T-tube was removed after biliary irrigation. Conclusion Laparoscopic cholecystectomy plus choledocholithotomy is feasible and safe.

关 键 词：残余胆囊 腹腔镜 胆总管切开取石 胆道镜取石 T管窦道 腹腔镜胆道探查 

分 类 号：R473[医药卫生—护理学]