腹腔镜胆道镜十二指肠镜术中联合治疗胆总管下端嵌顿结石  

Intraoperative use of laparoscope choledochoscope duodenoscope for common bile duct stone occluded at the far end of common bile duct

作　　者：马海 尹思能[2] 王德荣 李青亮[2] 张诗诚[2] 

机构地区：[1]南充市中心医院肝胆外科,四川南充673000 [2]成都市第二人民医院肝胆外科,四川成都610017

出　　处：《川北医学院学报》2003年第2期54-57,共4页Journal of North Sichuan Medical College

摘　　要：目的评价腹腔镜 ,胆道镜 ,十二指肠镜三镜联合处理胆管下端嵌顿结石的疗效。方法 2 0 0 0年 2月到 2 0 0 2年 7月用三镜联合处理胆总管下端嵌顿结石 2 3例。其中 ,2例有开腹胆囊切除手术史 ,1例有腹腔镜胆囊切除史。结果 1例术中结石未取出 ,安置T管 ,术后通过T管窦道激光碎石。 2 2例嵌顿结石取出后 ,胆管一期缝合 ,4例术后保留鼻胆管引流 ,14例术后保留输尿管导管引流。 1例术后胰腺炎 ,手术并发症率 4.3 % ,无死亡。结论术中三镜联合处理胆总管下端嵌顿结石创伤小、并发症和死亡率低 。Objective The effectiveness of the combined use of laparoscope, choledochoscope, and duodenoscope for occluded stone at the far end of common bile duct is assessed retrospectively.Methods 23 cases had been performed between Feb 2000 and Jul 2002 in our two hospitals. 2 patients had a previous open cholecystectomy, 1patient had a previous laparoscopic cholecystectomy.Results 1 case was not success in extracting the occluded stone, a T-tube was inserted in the common bile duct, and the stone was broke to pieces by ESWL through the T-tube tract 2 months after operation. Primary common bile duct closure was followed after the 22 cases of successful extraction of their occluded stones. Among them 4 cases had preserved nasal bile duct drain, and 14 cases had a ureter catheter insert through the cystic duct for post operation bile duct drainage.Morbidity rate was 4.3%. No death.Conclusion The combined use of laparoscope, choledochoscope, and duodenoscope is a safe and effective approach with minimal invasion, low morbidity rate and no death for patients with occluded stone at the distal end of common bile duct and primary duct closure could be performed when occluded stones were extracted successfully.

关 键 词：胆管下端嵌顿结石 腹腔镜 胆道镜 十二指肠镜术 联合治疗 疗效 

分 类 号：R657.4[医药卫生—外科学]