中国实用外科杂志

中国实用外科杂志

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腹腔镜胆囊切除术中经胆囊管胆总管探查诊治胆总管结石价值分析

朱杰高，吴鸿伟，刘    坤，汪    栋，刘    军，郭    伟，张忠涛   

  1. 首都医科大学附属北京友谊医院普外科，北京 100050
  • 出版日期:2022-04-01

  • Online:2022-04-01

摘要： 目的    探讨腹腔镜经胆囊管胆总管探查术（LTCBDE）对磁共振胰胆管成像（MRCP）检查阴性的胆总管结石的诊断及治疗价值。方法    回顾性分析2008年1月至2019年12月首都医科大学附属北京友谊医院收治的有高度胆总管结石可能，但术前MRCP检查阴性的832例胆囊结石病人的临床资料。腹腔镜胆囊切除术（LC）中行LTCBDE明确诊断胆总管结石，并行胆总管取石治疗。主要观察指标为住院期间并发症发生率、经胆囊管探查成功率和结石阳性率。结果    772例病人成功完成了LTCBDE，探查成功率为92.8%。418例（54.1%）病人发现胆总管内泥沙样结石或成形结石，415例病人经胆囊管途径取石成功，取石成功率为99.3%。随访时间为5.2（3.2~7.7）年，共9例病人发生并发症，并发症发生率为1.1%，其中胆瘘2例，术后残留结石3例；354例无胆总管结石病人术后无并发症发生。结论    对于高度胆总管结石可能的胆囊结石病人，当术前MRCP检查阴性时，建议LC术中行LTCBDE；LTCBDE安全、可行，具有较高的探查和取石成功率，能够同期实现诊断和治疗的目标。

关键词: 胆囊结石, 腹腔镜, 胆总管探查术, 胆总管结石, 磁共振胰胆管成像

Abstract: The diagnosis and treatment value of laparoscopic cholecystectomy combined with intraoperative transcystic common bile duct exploration for choledocholithiasis        ZHU Jie-gao，WU Hong-wei，LIU Kun，et al. Department of General Surgery，Beijing Friendship Hospital，Capital Medical University，Beijing 100050，China
Corresponding author：WANG Dong，E-mail：wangdong@ccmu.edu.cn；GUO Wei，E-mail：guowei@ccmu.edu.cn
Abstract    Objective    To investigate the efficacy and safety of laparoscopic transcystic common bile duct exploration (LTCBDE) in the diagnosis of choledocholithiasis in gallstone patients with negative MRCP. Methods    The clinical data of 832 gallstone patients with high possibility of choledocholithiasis but negative MRCP admitted in Beijing Friendship Hospital, Capital Medical University From January 2008 to December 2019 were analyzed retrospectively. LTCBDE was performed during laparoscopic cholecystectomy（LC）to make the diagnosis and management of choledocholithiasis. The main outcomes were the incidence of complications during hospitalization, the success rate of LTCBDE and the positive rate of choledocholithiasis. Results    A total of 772 patients successfully completed LTCBDE and the success rate was 92.8%. Choledocholithiasis was found in 418 patients（54.1%），and 415 patients were successfully removed through the cystic duct. The success rate of stone removal was 99.3%. During the follow-up period of 5.2（interquartile range 3.2-7.7）years，9 patients developed complications. The overall rate of complications was 1.1%，including 2 cases of bile leakage and 3 cases of postoperative residual stones. There were no postoperative complications in 354 patients without choledocholithiasis. Conclusion    For gallstone patients with high risk of choledocholithiasis，when the preoperative MRCP examination fails to identify bile duct stones，it is recommended to perform LTCBDE during LC. LTCBDE has lower risk of complications，higher success rate of exploration and stone removal，and can complete the goal of diagnosis and treatment at the same time.

Key words: gallbladder stone, laparoscope, common bile duct exploration, common bile duct stones, magnetic resonance cholangiopancreatography