摘要
目的:探讨腹腔镜胆囊切除术中应用纤维胆道镜治疗胆总管并发结石的入路及临床意义。方法:采用Olympus P20胆道镜对64例胆囊结石并发胆总管结石选择性施行胆道探查取石术,其中经胆囊管入路26例,胆总管前壁切开入路38例。结果:①经胆囊管入路取净结石24例,残留结石2例,术后经内镜十二指肠乳头肝胰壶腹括约肌切开(EST)取石成功。②经胆总管前壁切开入路取出结石34例,推入十二指肠3例,阴性探查1例。一期缝合17例,术后胆漏2例,引流1周内愈合;置放T形管21例,术后无胆漏。残留结石1例,经T形管窦道取石成功。结论:腹腔镜术中经胆囊管入路胆道镜胆总管探查取石,创伤小、痛苦轻、恢复快,但对不适宜的患者仍应坚持切开胆总管前壁,探查取石后酌情行一期缝合或置放T形管引流。
Objective：To investigate the indications and clinical value of different fibercholangioscopic entry to extract common bile duct stones during laparoscopic cholecystectomy. Methods ： Exploration of biliary tracts were made by fibercholangioscopy （ Olympus P20 ） in 64 patients with gallbladder stones and common bile duct stones,who underwent laparoscopic cholecystectomy. Common bile duct stones were extracted via cystic duct in 26 cases and via choledochotomy in 38 cases. Results：（1）Common bile duct stones were successfully extracted via cystic duct in 24 cases. Residual stones were taken out via endoscopic sphincterotomy（EST） in 2 cases. （2）Common bile duct stones were successfully extracted via choledochotomy in 34 cases ,and pushed through Oddi＇s sphincter in 3 cases. No stone was found in one patient. Prima- ry closure of laparoscopic choledochotomy was performed in 17 cases with postoperative bile leakage and 2 cases were cured within one week. Twenty-one patients underwent T-tube drainage without postoperative bile leakage. Residual stones were taken out by fibercholangloscopy via T-tube sinus in one patient. Conclusion： Extracting common bile duct stones by fibercholangioscopy via cystic duct during laparoscopic cholecystectomy is mini-invasive,less painful and quick in recovery for patients with cholecystolithiasis and complicated choledocholithiasis. Extracting stones via choledochotomy with primary closure or T-tube drainage remains an option for the patients unsuited for extraction via cystic duct.
出处
《华北国防医药》
2008年第5期12-14,共3页
Medical Journal of Beijing Military Region
关键词
胆囊结石病
胆总管结石
腹腔镜检查
探查取石
入路选择
Cholecystolithiasis
Choledocholithiasis
Laparoscopy
Examining and extracting stone
Entry selection
