腹腔镜胆总管探查取石术123例临床剖析.docVIP

腹腔镜胆总管探查取石术123例临床剖析 　　【摘要】目的 探讨腹腔镜下胆总管探查术（Laparoscopic common bile duct exploration, LCBDE）的适应证、方法、优点。方法 回顾分析2003年10月～2005年3月我科123例LCBDE的临床资料，全部病例术前经B超、MRCP明确胆总管结石，腹腔镜下胆总管切开经纤维胆道镜取石后，置T管引流102例，一期缝合19例。结果 121例成功行LCBDE，2例中转开腹，手术时间（115±40）min?，住院时间6~10天，T管引流4~8周拔管，5例出现轻微胆漏，保守治疗4~10天治愈。残余结石15例，术后6周经T管窦道胆道镜取出。病例随访6~22月无残余结石及胆道狭窄。结论 LCBDE具有微创、低并发症等优点，有较高的临床价值。 　　【关键词】腹腔镜； 胆总管探查；一期缝合 　　 　　Clinical Analysis of 123 Cases with Laparoscopic Common Bile Duct Exploration LI Jin-bo1，SUO Yun-sheng2.(1.Department of Hepatobiliary Surgery，Hongya County People’s Hospital ，Hongya 620360，China；2.Department of Surgery，The Second People’s Hospital of Chengdu，Chengdu 610017，China) 　　 【Abstract】Objective Discuss the methods and effect of common bile duct(CBD) operation by laparoscopic procedure after laparoscopic cholecystectomy （LC）.Methods study 123 examples of LCBDE operated in our department between november 2003 to march 2005,all of them were diagnosed CBD gallstone by type-B ultrasonic or MRCP ,After the CBD stone was removed by choledochofiberscopy completely ,102 cases were T-tube conducted,19 cases were sutured primarily.Results 121 cases of CBD gallstone were operated successfully ,2 celiotomy in operation ,5 cases had slight bile leakage,and cured in conservative way in 4~10 days,15 patients had residual stones，and all residual stones were removed 6 weeks later.all cases were followed-up for 6～22months,no bile duct stricture and residual stone were found.Conclusion LCBDE is safe、 effective 、 micresoft and low complicated in laparoscopic CBD exploration ,it has superior clinical value. 　　【Keywords】Laparoscopic;Common bile duct(CBD) exploration;Suture primarily 　　【中图分类号】R657.4+2 　　【文献标识码】A 　　【文章编号】1814-8824(2009)-05-0005-02 　　 　　 2003年10月～2005年3月我院共施行腹腔镜下胆总管探查术（Laparoscopic common bile duct exploration, LCBDE）123例，现将结果报道如下。 　　 　　1 资料与方法 　　 　　1.1 临床资料 本组123例，女75例，男48例 ,32～75岁，平均年龄53岁，病史5周～15年；所有患者均有不同程度的右上腹间歇性疼痛，伴或不伴背心、肩部放射痛，术前经B超、磁共振胆胰管造影（MRCP）明确胆总管结石，胆总管内径10~20mm，