腹腔镜联合胆道镜治疗胆总管结石38 例.docVIP

腹腔镜联合胆道镜治疗胆总管结石38 例【摘 要】 目的: 探讨腹腔镜联合胆道镜在治疗胆总管结石中的临床应用。方法:回顾性分析38 例采用腹腔镜、胆道镜联合治疗的胆总管结石患者资料。结果:本组腹腔镜联合胆道镜行胆总管探查取石术成功率97.4%(37/38),1例中转开腹,1例术中探查胆总管未见结石,1例术后胆总管残留结石1枚,2例合并肝内胆管多发结石,均于术后6~8周经T管窦道行胆道镜取石。手术时间90～190min ,术中出血量10～200mL ,术后住院5～10d。结论:腹腔镜联合胆道镜治疗胆总管结石具有微创、安全、疗效肯定、并发症少、恢复快等优点。? 【关键词】 腹腔镜 胆道镜 胆总管结石 Treatment of 38 cases common bile duct stones by laparoscopic treatment of biliary tract mirror? Shi Shulong? 【Abstract】 Objective:To evaluate the laparoscopic biliary tract surgery in the treatment of common bile duct stones in the clinical application. Methods:A retrospective analysis of 38 cases of laparoscopic biliary mirror the treatment of the common bile duct stones in patients with the information.Results:The laparoscopic biliary endoscope common bile duct exploration success rate of surgery 97.4% (37/38), 1 transit laparotomy, and 1 case of intraoperative bile duct exploration was no stone, 1 postoperative residual common bile duct stones 1, 2 cases with multiple intrahepatic bile duct stones, are 6 to 8 weeks after operation through the T tube sinus OK cholangioscopy stone. Operative time was 90~190min, blood loss 10~200mL, postoperative hospital stay 5~10d.Conclusion:The laparoscopic treatment of common bile duct stones with biliary mirror minimally invasive, safe, effective affirmative, less complications and faster recovery and so on. 【Key words】 Laparoscopic Oledochoscope Choledochoscope 胆总管结石是一种临床上较常见的良性胆道疾病,常继发于胆囊结石之后,传统疗法是开腹行胆囊切除, 胆总管切开取石, T管引流术,创伤大,住院时间长。我院于2005 年5 月~2008 年5 月, 行腹腔镜联合胆道镜治疗胆总管结石38 例,疗效较好,现总结报告如下。 1 临床资料与方法? 1.1 一般资料。本组男23 例,女15 例;年龄24～68 岁,平均46.2 岁。病程3 天～6 年,平均5 个月,急诊手术8 例,择期手术30 例,其中黄疸24 例,所有病例均经腹部B 超、CT检查证实为胆道结石,其中单纯胆总管结石4 例,胆囊结石合并胆总管结石22 例,胆囊结石合并胆囊炎、胆总管结石10 例,胆囊结石合并胆总管结石伴肝内胆管多发结石2例。胆总管直径1.2～2.5cm。? 1.2 器械设备。全套腹腔镜(德国Storz)及电视纤维胆道镜(日本Olympus CHF-P20 型) ,配套取石网篮,腹腔镜用持针器,胆总管穿刺针、可吸收带针缝线。? 1.3 方法。采用气管内插管静脉复合全身麻醉,常规建立人工气腹,压力13mmhg,按常规四孔法切除胆囊后于胆囊管和胆总管交汇处选择无血管区纵行切开胆总管前壁约1.5～2cm,先后通过:①器械取石法: 应用腹腔镜专用弯分离钳或取石钳直接取出胆总管切口