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1、腹腔镜联合纤维胆道镜胆总管探查术21例研究【摘要】目的总结腹腔镜联合纤维胆道镜治疗胆囊结石合并肝外胆管结石的体会,评估腹腔镜联合纤维胆道镜治疗胆石症的临床疗效｡方法回顾性分析21例行腹腔镜胆总管切开探查､纤维胆道镜取石､胆道扩张及T管引流术(laparoscopiccholedochotomyT�tubedrainage,LCTD)患者的临床资料｡结果21例中4例术前行ERCP+EST,手术成功20例,手术时间70～180min,平均120min,1例因术中病理示胆囊黏液腺癌,中转开腹行胆囊癌根治术,18例留
2、置T管｡患者术后第1天均可下床活动和进食,术后12d行T管造影夹闭T管｡术后30～40d(平均34d)拔除T管,2例发生胆漏,其余病例无胆道狭窄､胆道出血和残余结石等手术并发症｡1例术后2个月胆管结石复发经T管窦道取石｡结论腹腔镜胆总管探查术具有创伤轻､患者痛苦小､康复快､腹腔脏器干扰少等优点,同时能取得与开腹手术相同的治疗效果,是目前微创治疗胆囊结石并复杂性胆管结石较理想的方法,值得推广应用｡�【关键词】腹腔镜术;纤维胆道镜;胆总管探查术
3、Analysisoflaparoscopycombinedwith11fibercholangioscopiccholedochotomyin21casesDAIJian-jun,QINJun.ChineseMedicineHospitalofTianmenCity,HubeiProvince,Tianmen431700,China�【Abstract】ObjectiveTosummarizetheexperiencesoflaparoscopycombinedwithfibercholangioscopyforthetreatmentofcholecystoli
4、thiasisandcholedocholithiasisandevaluatetheclinicalcurativeeffectofthemethod.MethodsTheclinicaldataof21casesundergonelaparoscopiccholedochotomyandT�tubedrainagewereretrospectivelyanalyzed.ResultsAmong21cases,4patientswereperformedERCPandESTpreoperatively,andoperationsweresucceededin20
5、cases.Theoperatingtimewas70～180min(average,120min).1casewasconvertedtolaparotomybecausegallbladdermucinousadenocarcinomawasdiagnosedbyfrozenpathologicalsection.T�tubewasindwelledincholedochusin18cases.Patientscouldgetoutofbedandtakefoodonthefirstdayafteroperation.T�tubevisualizationan
6、docclusioncouldbeperformedinthe12thday,andT�tubewaspulledoutin30～40days(average,34days)after11operation.Bileleakagewasfoundin2cases,butnopostoperativecomplicationshappenedintheothers,suchasstenosisofthebiliarytract,hematobiliaandresidualstone.Calculusofbileductrecurredin1casein2months
7、afteroperation,andwasremovedbyfibercholedochoscopethroughT�tubesinustract.ConclusionThelaparoscopiccholedochotomyhasmanyadvantages,suchasminordamage,lesssuffering,rapidrecoveryandlessdysfunctionofvisceralorgans,andcanachievethesameeffectsaslaparotomy,andisabetterminimallyinvasivetreat
8、mentf
