中国实用外科杂志

中国实用外科杂志

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腹腔镜经胆囊管胆道探查取石术32例报告

范雄伟1，2，杨海涛1，郭    伟2，张忠涛2   

  1. 1宁夏医科大学附属吴忠市人民医院普外科，宁夏吴忠 751100；2 首都医科大学附属北京友谊医院普外科，北京 100050
  • 出版日期:2018-02-01 发布日期:2018-02-24

  • Online:2018-02-01 Published:2018-02-24

摘要：

目的    探讨基层医院采用常规5 mm胆道镜开展腹腔镜经胆囊管胆道探查取石术（LTCBDE）治疗胆总管结石的可行性及临床经验。 方法    回顾性分析宁夏医科大学附属吴忠市人民医院 2015 年 6 月 至2016 年4 月实施LTCBDE治疗胆囊结石合并胆总管结石的32例病人临床资料及其疗效。32例病人术前均通过B超、CT和（或）MRCP检查证实胆囊结石合并胆总管结石。结果    32例病人胆总管直径8～15 mm；CT或MRCP显示胆囊管直径≥3 mm；胆总管内结石直径3～8 mm，结石数目1～3枚。成功完成LTCBDE手术30例，未成功2例。成功率93.8%。手术时间（96.2±32.5）min，术后住院时间（3.5±2.1）d， 2例（6.3%）术后发生胆漏。有8例病人术中因结石较大，应用汇入部微切开技术完成取石。院外随访10～22个月，未发现胆道狭窄及结石残留与复发。结论   严格把握手术适应证，熟练掌握手术技巧后，在基层医院采用常规5 mm胆道镜开展LTCBDE治疗胆囊结石并胆总管结石是可行的，值得推广。

关键词: 腹腔镜, 胆道镜, 胆总管结石, 胆道探查术

Abstract:

Laparoscopic transcystic bile duct exploration：An analysis of 32 cases        FAN Xiong-wei*, YANG Hai-tao, GUO Wei, et al.*Department of General Surgery, Wuzhong People's Hospital Affiliated to Ningxia Medical University, Wuzhong 751100, China
Corresponding author: GUO Wei, E-mail：guoweibfh@163.com
Abstract    Objective    To investigate the feasibility of laparoscopic transcystic biliary duct exploration (LTCBDE) for the treatment of common bile duct (CBD) stones by using 5 mm conventional choledochoscope in the basic-level hospital. Methods    The clinical data and outcomes of 32 cases of gallstone and CBD stones treated by LTCBDE in Wuzhong People's Hospital Affiliated to Ningxia Medical University from June 2015 to April 2016 were analyzed retrospectively. All the cases were diagnosed with gallstone accompanying CBD stones preoperatively by ultrasonography, CT and (or) MRCP. Results    The diameter of CBDs were 8 to 15 mm. CT or MRCP showed the diameter of the cystic ducts were more than 3 mm. The number of CBD stones were 1 to 3, and the diameter were 3 to 8 mm. Thirty of 32 cases of LTCBDE were successfully performed with the success rate of 93.8% (30/32). The average operation time was (96.2±32.5) min, and the average postoperative hospital stay was (3.5±2.1) d, and the incidence of complications was 6.3% (2/32). There were 8 cases of large stones during the operation, and the microincision technique was used to complete the stone removal. After 10 to 22 months of out-hospital follow-up, no biliary stricture, residual stones and recurrence were found. Conclusion    It is feasible that the LTCBDE using conventional 5 mm choledochoscope can be applied in basic-level hospital when the patients are well selected and the surgeons are well trained. Thus, the technique is worthy to be popularized in the basic-level hospitals.

Key words: laparoscopy, choledochoscopy, common bile duct stone, bile duct exploration