三孔法腹腔镜胆囊切除胆总管探查取石术的经验总结  

Clinical experience of three-port laparoscopic cholecystectomy combined with common bile duct exploration for choledocholithiasis with cholecystolithiasis

作　　者：付建柱[1] 计嘉军[1] 高峡[1] 于则利[1] FU Jian-zhu;JI Jia-jun;GAO Xia(Department of General Surgery,Beijing Tongren Hospital,Cap-ital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院

出　　处：《腹腔镜外科杂志》2020年第2期126-128,133,共4页Journal of Laparoscopic Surgery

摘　　要：目的:总结三孔法腹腔镜胆囊切除胆总管探查取石术治疗胆囊结石合并胆总管结石的临床经验。方法:总结2014年1月至2019年8月接受三孔法腹腔镜胆囊切除胆道探查取石术的144例胆囊结石合并胆总管结石患者的临床资料,具体探查方式根据患者情况选择,总结分析患者的临床特点、手术效果、术后恢复及并发症情况。结果:144例患者中32例经胆囊管探查,88例采用胆囊管汇入部微切开,24例采用胆总管切开方式;其中2例因手术暴露困难加用辅助孔完成手术,无一例中转开腹。术中3例放置T管,术后行胆道镜治疗。术后10例发生胆漏,保守治疗后3~7 d痊愈。结论:三孔法腹腔镜下胆总管探查取石术是治疗胆囊结石合并胆总管结石合理、有效的术式,术中胆道镜的应用及胆管缝合是手术成功的关键。Objective:To summarize the experience of three-port laparoscopic cholecystectomy(LC)combined with laparoscopic common bile duct exploration(LCBDE)for choledocholithiasis with cholecystolithiasis.Methods:From Jan.2014 to Aug.2019,three-port LC+LCBDE was successfully completed in 144 patients of choledocholithiasis combined with cholecystolithiasis.Medical data were retrospectively collected and analyzed including clinical characteristics,surgical outcomes,postoperative recovery,and complication.Results:LCBDE was performed successfully in 32 cases through cystic duct,while 88 cases through the mini-incision at insertion of cystic duct,and 24 cases through direct incision at common bile duct.2 patients needed additional Trocar because of the difficulty in surgical field exposure.No case was converted to open operation.3 cases were placed T-tube in the operation.Bile leakage occurred in 10 patients postoperatively,and recovered after 3-7 d of conservative treatment.Conclusions:Three-port LC+LCBDE is a safe and effective surgical approach for patients with cholecystolithiasis and choledocholithiasis.Specialized techniques in intraoperative choledochoscopy and bile duct suture are important factors for the success of surgery.

关 键 词：胆囊结石病 胆总管结石 胆道镜检查 胆囊切除术 腹腔镜 

分 类 号：R657.4[医药卫生—外科学]