摘要
目的探讨腹腔镜联合胆道镜经胆囊管探查治疗胆囊结石合并胆总管结石的临床价值。方法 2013年10月~2015年7月对20例胆囊结石合并胆总管结石行腹腔镜胆囊切除,胆道镜经胆囊管探查胆总管,并取出胆总管较小结石,较大结石行汇入部微切开后取出,再将胆囊管成形缝合夹闭。结果 20例均完成腹腔镜联合胆道镜经胆囊管探查取石术,其中4例因胆总管结石较大,行胆囊管汇入胆总管处微切开取石,一期缝合汇入部。20例胆总管结石全部取净,胆总管结石大小0.2~1.0 cm,其中3例为泥沙样结石。手术时间78~195 min,(96.2±21.8)min;术中出血量25~100 ml,(32.8±10.2)ml;术后住院3~10 d,(3.5±1.5)d。1例发生胆漏,保留腹腔引流10 d后痊愈出院。20例随访6~26个月(中位数11个月),无胆道感染和胆管狭窄发生,无结石复发。结论腹腔镜联合胆道镜经胆囊管探查治疗胆囊结石合并胆总管结石疗效满意。
Objective To explore the clinical value of laparoscopy combined with choledochoscopy in the treatment of common bile duct stones with concurrent gallbladder stones. Methods A total of 20 patients with cholelithiasis received laparoscopic transcystic common bile duct exploration combined with superfine choledochofiberscopy and double-frequency laser cholelithotripsy from October 2013 to July 2015. All the patients underwent laparoscopic cholecystectomy and bile duct exploration of common bile duct. The small bile duct stones were removed directly and the large stones were removed after a micro-incision at the confluence part. Then the gallbladder tube was clipped and sutured. Results All the 20 cases of common bile duct stones with concurrent gallbladder stones were successfully treated with laparoscopic choledochoscopy and laparoscopic cholecystectomy. Due to the large size of stones in common bile duct in 4 cases,incisions for bile duct exploration were made in the junction of cystic duct and common bile duct,and the incisions were primarily sutured after successful removal of stones. The size of stones impacted in the common bile duct ranged from0. 2- 1. 0 cm,including 3 cases of mixed sludge and stones. The operation time was 78- 195 min（ mean,96. 2 ± 21. 8 min）,the amount of intraoperative bleeding was 25- 100 ml（ mean,32. 8 ± 10. 2 ml）,and the postoperative hospital stay was 3- 10 d（ mean,3. 5 ± 1. 5 d）. Postoperative bile leakage occurred in 1 case and was cured after 10 days of abdominal drainage. All the 20 cases were followed up for 6- 26 months（ median,11 months）. No infection of bile duct or bile duct stricture occurred. Conclusion Laparoscopy combined with choledochoscopy in the treatment of common bile duct stones can achieve satisfactory efficacy.
出处
《中国微创外科杂志》
CSCD
北大核心
2017年第2期189-192,共4页
Chinese Journal of Minimally Invasive Surgery
关键词
腹腔镜
胆道镜
胆囊结石
胆总管结石
胆道探查
Laparoscopy
Choledochoscopy
Gallbladder stone
Common bile duct stone
Bile duct exploration
