摘要
目的：探讨腹腔镜再次胆道探查术治疗胆管结石的方法和临床应用价值。方法：回顾分析为31例复发性胆管结石患者施行腹腔镜胆道探查取石术的临床资料。结果：31例中2例因腹腔粘连致密,胆道周围组织充血水肿严重而中转开腹。29例完成腹腔镜手术,其中1例因胆总管结石大,1例胆总管下端结石嵌顿,1例肝内胆管结石较多,胆道镜和取石钳取石困难,剑突下切口延长至3~4 cm,直视下用取石钳联合胆道镜取石。行胆总管一期缝合5例,24例行胆总管T管引流术。手术时间平均170 min。术后均无腹腔出血和肠漏等并发症发生。3例出现少量胆漏,未出现腹膜炎和腹内感染征象,腹腔引流管分别于术后第6,9,10天拔除。2例剑突下切口感染均是切口延长者,通过局部换药愈合。胆总管一期缝合5例,术后5~7 d出院。24例行胆总管T管引流的患者中,10例于术后7 d带T管出院,14例于术后14 d夹闭T管后带管出院。术中19例结石取净,10例胆道残余结石患者于术后2个月经胆道镜取出。结论：腹腔镜再次胆道探查术安全,患者创伤小,康复快。胆管炎症严重及肝内外结石较多、胆总管下端结石嵌顿者需慎重选择腹腔镜手术。
Objective：To evaluate the clinical application and methods of laparoscopic bile duct reexploration for patients with bile duct calculi.Methods：The clinical data of 31 patients with recurrent bile duct calculi who underwent laparoscopic bile duct reexploration were analyzed retrospectively.Results：Of the 31 patients treated by this procedure,2 cases required conversions to open surgery because of extensive dense adhesions,tissue edema and congestion.Another 29 operations were completed laparoscopically.Bile duct calculi were removed directly using forceps and flexible choledochoscope through the enlarged incision of epigastric port in 1 case with large calculi,1 case with incarcerated calculi at inferior end of common bile duct,and 1 case with multiple intrahepatic calculi.A T-tube was inserted in 24 patients and the common bile duct was closed primarily in 5 cases.The median operative time was 170 min.No major complications such as abdominal bleeding or bowel leakage were observed.Mild bile leakage but no peritonitis or peritoneal infection occurred in 3 cases.These were treated successfully with postoperative drainage with no further surgery required,and the drainage tubes were removed on day 6,9,and 10 after operation respectively.Wound infection of epigastric port occurred in 2 cases whose incision had been extended and were cured by change dressing.Five patients with primary closure were discharged at 5-7 day after operation.Of 24 patients with T-tube,10 were discharged with T-tube in situ 7 days after operation,and another 14 discharged after T-tubes were closed 14 days after operation.Retained bile duct calculi in 10 cases were removed by choledochoscope through T-tube sinus tract 2 months after operation.Conclusions：Laparoscopic bile duct reexploration can be performed safely and effectively.The procedure is less traumatic with faster recovery.It should be considered carefully to choose the procedure for the patients with severe cholangitis,multiple intrahepatic and extrahepatic calculi and impacted calculi at distal end of common bile duct.
出处
《腹腔镜外科杂志》
2011年第7期507-509,共3页
Journal of Laparoscopic Surgery
关键词
胆结石
腹腔镜检查
胆道探查
Cholelithiasis
Laparoscopy
Bile duct exploration
