510例腹腔镜联合纤维胆道镜胆总管切开取石术临床应用.doc

510例腹腔镜联合纤维胆道镜胆总管切开取石术临床应用 　【摘要】 目的 探讨腹腔镜联合纤维胆道镜治疗胆总管结石的可行性及临床应用价值。方法 1998年～2007年对510例患者行腹腔镜胆总管切开取石（laparoscopic common duct exploration，LCDE），与同期300例开腹（open surgery，OS）手术者比较。术前确诊者，术中直接行胆总管切开胆道镜取石；术前有黄疸史、胰腺炎史和(或)直接胆红素增高、胆系酶(AKP、GGT)增高者，或胆总管在0.8 cm以上者行术中造影，明确有胆总管结石的切开胆总管胆道镜取石。405例置T管引流（留置T管组），105例行胆总管Ⅰ期缝合（I期缝合组）。结果 手术均获成功，与OS组比较，手术时间、术中出血量、术后并发症发生率（胆瘘、出血）差异无统计学意义；住院日、术后镇痛药使用次数、腹腔或切口感染率、残石率明显减少。无中转开腹。30例T管引流口靠近肋弓而引起术后疼痛，2例术后2 d T管才引流出胆汁。留置T管组有24例胆总管残余结石，3月后经胆道镜取石成功。留置T管组手术时间平均（110±15）min，平均术后住院8 d；Ⅰ期缝合组手术时间（95±8）min，平均术后住院5 d。结论 LCDE是治疗胆总管结石安全、有效的方法，同样可起到创伤小、痛苦轻、恢复快、住院时间缩短等微创效果，如能在取净结石的情况下行胆总管Ⅰ期缝合，微创效果尤为明显。 【关键词】 腹腔镜 纤维胆道镜 胆总管切开取石 Choledocholithiasis treated with laparoscope combined with fibrocholedochoscope Abstract Objective To study the feasibility and clinical application of laparoscopic surgery for choledocholithiasis. Methods 510 patients with choledocholithiasis were undergone laparoscopic common bile duct exploration. For those cases dignosed preoperatively， common bile duct was incised and the calculi were taken out with fibrocholedochoscope. Some patients had suffered from obstructive jaundice， pancreatitis， bilirubinemia， alkaline phosphatase (AKP) raise， γ-glutamyl transpeptidase (γ-GGT) raise and/or diameter of common bile duct exceeded 0.8 cm; and for these cases intraoperative cholangiography must be carried out. 405 cases needed T-tube insertion. The common bile duct of 105 cases was sutured without T tube. Results All cases were operated successfully. Total operative time was lightly longer (but no statistic difference) than that in the laparoscopy surgery group， with shorter hospital stay. No statistic difference was found between the two groups about bile leak， bleeding， and retained stones as well. 30 cases felt pain after operation because of the drainage tube stab. Bile did not drain off from T-tube in 2 cases until 2 days after operation. 24 cases with residual calculus were cured by fibrocholedochoscope 3 months after operation. The span of