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1、腹腔镜联合胆道镜行胆总管切开取石探查术156例临【摘要】目的:总结腹腔镜联合胆道镜行胆总管切开探查取石、T管引流术的临床体会。方法:先行腹腔镜胆囊切除术(laparoscopiccholecystectomy,LC),再切开胆总管,用特制的腹腔镜胆总管取石钳取石,胆道镜主要观察胆总管及肝内外胆管有无结石残余及是否通畅,必要时经胆道镜取石。结果:术后拔T管时出现胆漏3例,1例术后10dT管自胆总管脱出至腹腔,1例术后24h胆漏达400ml,6例中转开腹,余均痊愈出院,无残石及术后胆管狭窄等并发症发生。结论:腹
2、腔镜联合胆道镜行胆囊切除、胆总管切开探查取石、T管引流术具有安全可靠、患者损伤小、康复快、住院时间短等优点,是治疗胆囊结石、胆总管结石的有效术式。【关键词】腹腔镜术胆道镜胆总管结石 Laparoscopebinedyforstoneremovalandexplorationfor156cases 【Abstract】Objective:Tosummarizetheclinicalexperienceoflaparoscopebinedyforexploration,stoneremovalandTtu
3、bedrainage.Methods:Usingspeciallaparoscopic 腹腔镜联合胆道镜行胆总管切开取石探查术156例临【摘要】目的:总结腹腔镜联合胆道镜行胆总管切开探查取石、T管引流术的临床体会。方法:先行腹腔镜胆囊切除术(laparoscopiccholecystectomy,LC),再切开胆总管,用特制的腹腔镜胆总管取石钳取石,胆道镜主要观察胆总管及肝内外胆管有无结石残余及是否通畅,必要时经胆道镜取石。结果:术后拔T管时出现胆漏3例,1例术后10dT管自胆总管脱出至腹腔,1例术后24
4、h胆漏达400ml,6例中转开腹,余均痊愈出院,无残石及术后胆管狭窄等并发症发生。结论:腹腔镜联合胆道镜行胆囊切除、胆总管切开探查取石、T管引流术具有安全可靠、患者损伤小、康复快、住院时间短等优点,是治疗胆囊结石、胆总管结石的有效术式。【关键词】腹腔镜术胆道镜胆总管结石 Laparoscopebinedyforstoneremovalandexplorationfor156cases 【Abstract】Objective:Tosummarizetheclinicalexperienceoflaparo
5、scopebinedyforexploration,stoneremovalandTtubedrainage.Methods:Usingspeciallaparoscopiclithotomyforcepstoremovecalculusfrommonbileductafterlaparoscopiccholecystectomyandcholedochotomy.Choledochoscopeainlyusedtoobserveonbileduct.Ifnecessary,choledochoscope
6、couldtakethecalculiout.Results:AftertheremovalofTtube,bileleakageoccurredin3patients,1caseinthetenthdayafteroperation,Ttubeprolapsedtoabdomen,1caseinthe24haftertheoperation,400mlbileleaked,6casesyandcholedochotomyforexploration,stoneremovalandTtubedrain
7、ageissafeandreliable.Damageinpatientsareminor,orequicklyande.Thismethodisfeasibleintreatmentofcalculiingallbladderandbileduct. 【Keyonbileductcalculi 2004年3月至2007年3月我院成功开展了腹腔镜联合胆道镜行胆总管切开探查取石、T管引流术156例,临床效果满意。现报道如下。 1资料与方法 1.1临床资料本组156例中男51例,女105例。13~74岁
8、,平均45岁。通过病史、症状、体征、B超、CT或MRI确诊。术前排除肝内胆管结石、狭窄及肿瘤。其中胆囊结石并胆总管结石125例,多为胆总管继发性结石,单纯胆总管结石30例,胆总管结石合并下端肿瘤1例。 1.2手术方法术前准备同腹腔镜胆囊切除术(laparoscopiccholecystectomy,LC),除患者肥胖、腹胀或估计手术时间长外,一般不需作肠道准备、置胃管及导尿管。本组均采用气管插管静脉全身麻醉。体