腹腔镜胆道镜联合钬激光治疗胆总管难取性结石的技术及效果分析.docVIP

腹腔镜胆道镜联合钬激光治疗胆总管难取性结石的技术及效果分析 　　【摘要】 目的：探讨腹腔镜、胆道镜联合钬激光治疗胆总管难取性结石的技术、安全性及效果。方法：回顾分析笔者所在医院2010年1月-2015年1月应用腹腔镜、胆道镜联合钬激光治疗31例胆总管难取性结石的临床资料。结果：30例患者均一次性碎石、取石成功，术后2例胆漏，经T管证实1例胆总管缝合处渗漏，1例T管横臂呈弓状部分脱出，经延长腹腔引流管放置时间，术后15 d左右自愈。术后5～6周经T管造影显示胆总管无残留结石、下端通畅后拔管。另外1例结石嵌顿于胆总管下端，为70岁男性胆囊结石并胆总管结石患者，术中患者血压、血氧波动较大，为了避免手术时间过长，仅作胆囊切除、T管引流，术后6周利用胆道镜经窦道行钬激光碎石，彻底冲出粉碎的细小结石，再次胆道镜检查显示无残留结石、胆总管下端通畅，置引流管，1周后拔管。31例患者均得到随访，随访时间2～12个月，经B超或MRCP复查，未发现胆管残余结石或结石复发、无胆道狭窄。结论：腹腔镜、胆道镜联合钬激光碎石对胆总管难取性结石直观、准确、简化取石难度、疗效确切，未增加特殊副作用，是一种安全、可靠的腹腔镜下胆总管切开取石方法。 　　【关键词】 腹腔镜； 胆道镜； 钬激光； 胆总管难取性结石 　　中图分类号 R657.42 文献标识码 B 文章编号 1674-6805（2016）16-0110-03 　　【Abstract】 Objective：To investigate the technology，safety and effect of laparoscope and cholangioscopy combined with holmium laser for the treatment of difficult taken resistance stone of bile duct.Method：The clinical data of 31 cases of difficult taken resistance stone of bile duct in our hospital from January 2010 to January 2015 were retrospectively analyzed.Result：30 cases of lithotripsy and successful removal of the stones，2 cases of bile leakage after operation，through the T tube confirmed 1 case of common bile duct suture leakage，1 case T tube wishbone arched part of the prolapse，after prolonged peritoneal drainage tube placement time，postoperative 15 days self-healing.After 5 to 6 weeks after T tube radiography showed no residual stones in the common bile duct，the lower end of the patency after extubation.And 1 case of calculus incarcerated at the lower end of the common bile duct，70 years old male cholecystolithiasis and choledocholithiasis patients，intraoperative blood pressure，oxygen fluctuations larger，in order to avoid the operation time was too long，only for cholecystectomy，T tube drainage，postoperative 6 weeks used choledochoscope after sinus underwent holmium laser lithotripsy stone，completely out of the small stone crushing again choledochoscopy display no residual stones，common bile duct at the lower end of the unobstructed drainage tube，1 week afte