胆囊管汇入部微切开在腹腔镜胆道探查术中应用.docVIP

胆囊管汇入部微切开在腹腔镜胆道探查术中应用 　　【摘要】 目的：探讨腹腔镜胆道探查术中应用胆囊管汇入部微切开的方法与效果。方法：2012年 　　1月-2015年5月本院接诊腹腔镜胆道探查患者500多例，选取其中50例进行研究，抽取患者采取胆囊管取石困难，或胆囊管进入胆道镜困难，拟定胆囊管汇入部微切开处理，总结探查结果。结果：50例经胆囊管汇入部微切开联合腹腔镜胆道探查处理的患者，手术均顺利完成，无严重并发症发生，仅2例轻微胆囊管残端瘘；平均手术时间（95.29±37.16）min，平均术后住院时间（2.9±1.1）d；50例患者均随访半年以上，随访半年时均无胆道狭窄，仅1例因术后结扎夹游走而入胆总管再手术。结论：腹腔镜胆道探查术中应用胆囊管汇入部微切开处理，手术时间合理，住院时间短，且围术期与随访期间无严重并发症，安全性高，值得借鉴。 　　【关键词】 腹腔镜； 胆道探查术； 胆囊管汇入部； 微切开； 应用 　　【Abstract】 Objective：To investigate the method and effect of micro iincision of gallbladder duct in laparoscopic bile duct exploration.Method：In our hospital from January 2012 to May 2015 more than 500 patients with laparoscopic bile duct exploration，the selection of 50 patients with cystic duct stone extraction difficult，or cystic duct choledochoscope difficult to enter，cystic duct micro incision treatment，summarizing exploration results.Result：50 cases of cystic duct micro incision combined laparoscopic bile duct exploration treatment patients were successfully completed surgery，no serious complications occurred，only 2 cases of mild cystic duct stump fistula.The average operation time was （95.29±37.16）min，the mean postoperative hospitalization time was （2.9±1.1）d.50 patients were followed up for more than half a year，half a year follow-up were no biliary stricture，only 1 case with postoperative bile duct ligation in surgical clip walk.Conclusion：Laparoscopic exploration of the treatment of the bile duct in laparoscopic surgery，the operation time is reasonable，the length of hospital stay is short，and there is no serious complication，it is safety，it is worthy of reference. 　　【Key words】 Laparoscopic； Bile duct exploration； Bile duct exploration； Micro incision； Application 　　First-author’s address：The Second Hospital of Fushun City，Fushun 113001，China 　　doi：10.3969/j.issn.1674-4985.2016.12.014 　　胆道结石属于常见疾病，其中继发性诊断与治疗难度较大，近年随着腹腔镜技术应用广泛，腹腔镜经胆囊管胆道探查术在胆道结石诊疗中有不错效果。这种探查术减少了胆道切开与损伤，同时避免留置T管[1]，成为比较理想的微创方案。但是，从近年相关研究报告来看，因胆管途径进入弹道难度较大，或者取出结石难度较大，导致这种探查术成功率不高。同类