关键词: 腹腔镜, 急性胆管炎, 胆总管结石, 腹腔镜胆总管探查术, 内镜下鼻胆管引流术

Abstract:

Reasonable options and controversies of laparoscopic treatment for acute cholangitis        ZHAO Hai-ying，LIU Jin-gang. Department of General Surgery, the Fourth Affiliated Hospital of China Medical University，Shenyang 110032, China
Corresponding author：LIU Jin-gang，E-mail：liujg1347@sina.com
Abstract    Treatment option of acute cholangitis is closely related to diagnosis and severity assessment. For moderate and severe acute cholangitis，early biliary drainage should be performed. Both of China and aboard guidelines recommend endoscopic naso-biliary drainage （ENBD） as the first choice，and suggest that percutaneous transhepatic cholangial drainage （PTCD） and surgical operation may be considered as alternative methods. With the current technology and accurate severity assessment in acute cholangitis，emergency laparoscopic common bile duct exploration (LCBDE) can be performed safely and effectively for patients with mild and moderate acute cholangitis caused by common bile duct stones. For mild acute cholangitis，emergency LCBDE operation is the same as elective operation. For moderate acute cholangitis，massive bleeding and difficult suture due to thin or thick biliary wall may occur，which need special management even conversion to open operation when necessary. Surgical biliary drainage should be avoided in severe cholangitis. When ENBD and PTCD failed，or contraindications occurred，open surgical biliary drainage should be performed.

Key words: laparoscopy, acute cholangitis；common bile duct stones；laparoscopic common bile duct exploration（LCBDE）；endoscopic naso-biliary drainage（ENBD）