腹腔镜联合胆道镜在胆总管探查取石术中的应用【荐】.docVIP

腹腔镜联合胆道镜在胆总管探查取石术中的应用 　　作者：陈华锋　吴保忠　冯钢　杨帝宽 　作者单位： 526060 广东肇庆，肇庆市第二人民医院普外科(△微创外科) 　　【摘要】 目的 探讨腹腔镜联合胆道镜在胆总管探查取石术中的应用技术和常见并发症及其防治。方法 回顾分析2001～2005年39例腹腔镜联合胆道镜胆总管探查取石术患者临床资料。结果 Ⅰ期胆总管缝合的有16例，腹腔镜下放置T管引流的有19例。35例微创手术成功，4例中转开腹，T管术后14～19天拔管，平均住院时间10天，1例结石残留，并发胆漏2例。结论 腹腔镜联合胆道镜在胆总管探查取石术中的应用是安全可靠的，且创伤小，恢复较快。 　　【关键词】 腹腔镜;胆道镜;胆总管探查 　　Application of laparoscope combined with choledochoscope in common bile duct exploration and removing the stone 　　CHEN Hua-feng,WU Bao-zhong,FENG Gang,et al. 　　The Second Hospital of Zhaoqing,Guangdong 526060,China 　　【Abstract】 Objective To explore the application of laparoscope combined with choledochoscope in common bile duct exploration and removing the stone,prevention and cure for concerning complications.Methods Reviewed 39 cases of the laparoscopic common bile duct exploration from 2001 to 2005.Results 16 cases of primary closure of duct incision ,19 cases with T tube placement under laparoscope ,35 cases were successful,4 cases were conversion to open surgery,the 14～19 days after operation,T-duct was taken away.The median hospital stay was 10 days,1 case was failed to remove all the stone and 2 cases bile leakage.Conclusion Application of laparoscope combined with choledochoscope in common bile duct exploration and removing the stone is safe and small hurt and quick recovery. 　　【Key words】 laparoscopy;choledochoscopy;common bile duct exploration 　　胆石症是一种常见病，临床中胆囊结石合并胆总管结石并不少见。腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的疗效已得到公认。胆总管结石曾是手术禁忌证，需要中转开腹，但现在已无必要。我院从2001～2005年开展腹腔镜下胆总管探查取石术，T管引流或胆总管一期缝合术39例，疗效较满意，总结报告如下。 　　1 临床资料 　　1.1 一般资料 本组39例中男25例，女14例，男∶女为1.8∶1，年龄15～81岁，平均56岁;术前经B超、CT或ERCP等确诊为胆总管结石或胆总管扩张，32例合并有胆囊结石，合并肝内胆管结石的有12例，胆道蛔虫1例，4例合并有胆管炎，胆道肝吸虫3例，Mirizzi综合征1例，单纯胆总管下端狭窄2例;胆总管结石为单发或多发(2～8粒)，3例为泥沙样结石，胆总管直径11～29mm;均于气管全麻下行腹腔镜下胆总管探查取石术，行Ⅰ期 　　胆总管缝合的有16例，腹腔镜下放置T管引流19例。 　　1.2 手术方法 　　1.2.1 器械 德国Wolf腹腔镜全套，日本Olympus胆道镜，取石网篮，胆总管穿刺针、切开刀，无损伤带针缝线。 　　1.2.2 过程 (1)入腹：全麻下，头高体位，四点穿刺戳孔，同腹腔镜胆囊切除术。如果腹腔粘连较多，则适当