胆总管结石腹腔镜胆道探查术临床应用分析.docVIP

胆总管结石腹腔镜胆道探查术临床应用分析 　　摘要：目的探讨胆总管结石腹腔镜胆道探查术的临床意义。方法回顾我科2008年11月~2013年11月62例胆石病患者的临床资料，对患者手术方式、术中术后处理进行统计分析。结果62例患者行腹腔镜探查术中，胆总管切开T 管引流54例，胆总管切开一期缝合8例，中转开腹1例。既往腹部手术史者胆道探查15例，成功率100%。胆道探查成功61例，成功率98%，中转开腹1例，中转率2%。探查手术时间(110.50±27.43)min，术后1例（一期缝合）第3d出现胆汁漏。术后随访 1~24个月，胆道残余结石 2 例，无死亡病例。结论腹腔镜探查术具有创伤小、恢复快、费用低等特点，尤其适合胆囊结石合并胆总管结石的患者。但需要较高的腹腔镜操作技巧和严格的适应症把握。 　　关键词：胆总管结石;腹腔镜;探查术 　　Clinical Analysis of Laparoscopic Common Bile Duct Exploration of Common Bile Duct Stones 　　MIAO Wei-min 　　(Department of General Surgery,Shanghai Hudong Hospital,Shanghai 200129,China) 　　Abstract：ObjectiveA study on the clinical significance of aparoscopy for calculus of common bile duct.MethodsReview 62 patients clinical documentation of calculus of common bile duct carried out by the Department during Nov 2008~Nov 2013. Analyse the method and handling of in and post surgerys.Results54 of the 62 had the T duct cut for drainage. Ran primary sutures for 8 patients and abdominal cut for 1 partient. Ran biliary tract exploration for 15 patients who had abdominal surgery history and 100% success. 61 partients had their biliary duct explored successfully. The success rate had reached 98% with only 1 laparotomy which takes up 2%. Aparoscopy period is (110.50±27.43)min. One partent apperaed bile leakage 3 days after surgery. Follow up for 1~24 months and found stone residues on 2 patients. None dead case. ConclusionAparoscopy features of mini trauma, rapid recovery and low cost, esp suitable for gallstones and common bile duct stones. 　　Key words：Calculus of common bile duct;Peritoneoscopy;Aparoscoy1资料与方法 　　1.1一般资料本组患者共计62例，男41例（66.13%），女21例（33.87%）。年龄26～91 岁，平均年龄为60.6岁。既往腹部手术史 17例，其中下腹部手术史（阑尾切除术、盆腔手术等）10例，中上腹手术史（开腹胆囊切除术、开腹胆道探查术）7例，4例为开腹胆道取石术后复发。合并基础疾病26例，其中11例合并两种或两种以上疾病。 　　1.2 方法①全麻气腹后，采用四孔法，脐部置入腹腔镜孔Trocal，其余剑突下、右上腹于锁骨中线及右腋前线各置入操作孔Trocar。②钝性分离显露胆囊三角解剖,切断胆囊动脉,同法距胆总管0.3~0.5cm处,生物夹夹闭胆囊管,避免细小结石流入胆总管,并牵引固定胆总管。向外侧牵拉胆囊颈部,在胆囊管与胆总管汇合处下方,游离显露出下端胆总管长约1.0~2.0cm,电钩沿胆总管纵轴方向切开其前壁。吸净胆汁后,经剑突下Trocar伸入胆道镜,行胆总管探查。③使