胆道镜联合腹腔镜胆总管探查取石术应用于有腹腔镜上腹部手术史患者的研究  

Value of common bile duct exploration with laparoscopy and choledochoscopy in patients with history of upper abdominal operation

作　　者：张春礼[1] 秦至臻 胡鹏涛 王佳佳 马铁治 陈涛[1] Zhang Chunli;Qin Zhizhen;Hu Pengtao;Wang Jiajia;Ma Tiezhi;Chen Tao(No.2 Department of general surgeryZhengzhou People's Hospital(people's Hospital of Henan University of Chinese Medicine),Zhengzhou,450003,China)

机构地区：[1]郑州人民医院(河南中医药大学人民医院)普外二科,郑州450003

出　　处：《河南外科学杂志》2021年第6期14-16,共3页Henan Journal of Surgery

摘　　要：目的探讨胆道镜联合腹腔镜胆总管探查取石术(LCBDE)应用于有上腹部腹腔镜手术史患者的可行性及疗效。方法回顾性分析2019-01—2020-06郑州人民医院普外二科收治的有上腹部手术史的48例胆总管结石合并胆囊结石患者的临床资料。均应用纤维胆道镜联合LCBDE。统计LCBDE成功率以及患者术后恢复情况。结果因术中出血中转开腹1例。LCBDE手术成功47例(97.92%)。33例放置T管引流,术后1个月门诊复查,经T管造影,造影剂顺利进入十二指肠,未发现结石残留,拔除T管;14例行胆总管一期缝合,术后发生胆汁漏1例,经术中留置的引流管通畅引流3 d后停止,未发生腹腔感染等其他并发症。术后随访12个月,患者恢复良好,定期复查肝胆超声,未发现结石复发。结论对有上腹部腹腔镜手术史的胆总管结石合并胆囊结石患者,实施胆道镜联合LCBDE治疗,效果良好、并发症少,是安全、可行的治疗方法。但需严格掌握手术指征、规范进行手术操作,以及把握好中转开腹手术的时机。Objective To explore the feasibility and clinical effect of laparoscopic choledochoscopy combined with common bile duct exploration in patients with history of upper abdominal operation.Methods We retrospectively analyzed the data of 48 cases of common bile duct exploration,intraoperative choledochoscopy,T-tube drainage or primary suture from January 2019 to June 2020.Results the operation was successful in 47 cases,1 case was converted to open operation because bleeding,1 case was unable to enter the lower segment of the common bile duct by choledochoscopy,T tube drainage was performed in 32 cases after stone removal,14 cases were sutured in one stage after stone removal,among which 1 case was bile fistula,without bleeding or abdominal infection.The patients were followed up for 6~24 months.Conclusion Laparoscopy combined with choledochoscopy is safe and feasible in the patients with the history of upper abdominal operation,but it needs the chief surgeons who have experience in operation.

关 键 词：腹腔镜 纤维胆道镜 胆总管结石 

分 类 号：R657.4[医药卫生—外科学]