腹腔镜联合纤维胆道镜胆总管探查术２１例分析.doc

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1、腹腔镜联合纤维胆道镜胆总管探查术２１例分析【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“两镜”联合治疗胆石症的临床疗效。方法：回顾分析２００２年２月至２００６年６月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（laparoscopiccholedochotomyTtubedrainage,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粘液腺癌，中转开腹行胆囊癌根治术。１８例留置Ｔ管。患者术后第１

2、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。　　【关键词】腹腔镜术；纤维胆道镜；胆总管探查术　　Analysisoflaparoscopycombinedwithfibercholangioscopiccholedochotomy

3、in21cases　　【Abstract】Ｏbjective:Tosummarizetheexperiencesoflaparoscopycombinedwithfibercholangioscopyforthetreatmentofcholecystolithiasisandcholedocholithiasisandevaluatetheclinicalcurativeeffectofthemethod.Methods:Theclinicaldataof21casesundergonelaparoscopiccholedochotomyand

4、Ttubedrainagewereretrospectivelyanalyzed.Results:Among21cases,4patientswereperformedERCPandESTpreoperatively,andoperationsweresucceededin20cases.Theoperatingtimewas70180min(average,120min).Onecasewasconvertedtolaparotomybecausegallbladdermucinousadenocarcinomawasdiagnosedbyfr

5、ozenpathologicalsection.Ttubewasindwelledincholedochusin18cases.Patientscouldgetoutofbedandtakefoodonthefirstdayafteroperation.Ttubevisualizationandocclusioncouldbeperformedinthe12thday,andTtubewaspulledoutin30４０days(average,34days)afteroperation.Bileleakagewasfoundin2cases,b

6、utnopostoperativecomplicationshappenedintheothers,suchasstenosisofthebiliarytract,hematobiliaandresidualstone.Calculusofbileductrecurredin1casein2monthsafteroperation,andwasremovedbyfibercholedochoscopethroughTtubesinustract.Conclusions:Thelaparoscopiccholedochotomyhasmanyadv

7、antages,suchasminordamage,lesssuffering,rapidrecoveryandlessdysfunctionofvisceralorgans,andcanachievethesameeffectsas5laparotomy,andisabetterminimallyinvasivetreatmentforcholecystolithiasisandcomplicatedcholedocholithiasis.　　【Keywords】Laparoscopy;Fibercholedochoscope;Choledoc

8、hotomy　　腹腔镜胆囊切除术（laparoscopiccholecystectomy，LC)因其创伤小，术后恢复快，并发症少等优点而