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1、腹腔镜下经胆囊管取石治疗胆囊结石合并胆总管继发结石32例体会摘要：目的探讨腹腔镜下经胆囊管胆道镜取石治疗胆囊结石合并胆总管继发微小结石的疗效及临床价值。方法对2009年10月-2013年10月攀枝花市十九冶医院肝胆胰外科32例胆囊结石合并胆总管继发微小结石的患者，行腹腔镜胆囊切除术后经胆囊管胆道镜取石治疗胆总管继发结石，观察其临床效果。结果32例均顺利完成经胆囊管胆道镜取石，所有患者均放置温氏孔引流管，未放置T管，术后2〜4d拔除，术后平均住院时间5d。术后对所有患者跟踪随访3月，无漏胆、结石残余、胆道感染等并发症发生。结论腹腔镜下经胆囊管胆道镜取石治疗胆囊结石合并胆总管继发微小结石，避免了传
2、统胆总管切开取石需放置T管引流，具有创伤小、恢复快、安全等优点，是治疗胆囊结石合并胆总管继发微小结石的理想术式，具有较高的临床应用价值。关键词：腹腔镜；胆总管继发结石；胆道镜；经胆囊管取石LaparoscopicTranscysticDuctExplorationinTreatmentofCholecystolithiasiswithCommonBileDuctStonesSecondarytotheExperienceof32CasesLIZheng-zong,ZHUWan-xi,ZHUPing(DepartmentofHepatobiliaryandPancreaticSurgery,Pa
3、nzhihuaCityNineteenMetallurgicalHospitalfanzhihua617023,Sichuan,China)Abstract：ObjectiveToinvestigatethelaparoscopicviathecysticductcholedochoscopelithotomytreatmentthecurativeeffectofgallbladderstonewithsecondarysmallcommonbileductcalculianditsclinicalvalue.MethodslinOctober2009toOctober2013,mr.zha
4、ng19smeltinghospitalGanDanYisurgical32casesofgallbladderstonewithsecondarysmallcommonbileductcalculipatients,lineafterlaparoscopiccholecystectomyviathecysticductcholedochoscopetreatsecondarybraverymanagerstonestone,observeitsclinicaleffect.Results32casesweresuccessfullycompletedbythecysticductbiliar
5、ylithotomylens,allpatientswereplaceditsholedrainagetube,nottoplacetheTtube,outafter2〜4days,theaveragehospitalizationtimeafter5days・Onallofthepatientsafter3monthsfollow-up,noresidualbileleakage,calculi,biliarycomplicationssuchasinfection.ConclusionLaparoscopiccysticductcholedochoscopelithotomytreatme
6、ntofgallbladderstonewithsecondarysmallcommonbileductcalculi,avoidthetraditionalcuttakebraverymanagerstoneneedtoputtheTtubedrainage,hastheadvantagesofsmalltrauma,rapidrecovery,security,isthetreatmentofgallbladderstonewithsecondarysmallcommonbileductcalculisurgery,hashighclinicalvalue・Keywords：Laparos
7、copic;Commonbileductstonessecondary;Choledochoscopy;Viacysticductstones1资料与方法1・1一般资料本组32例患者，男性21例，女性11例，年龄28〜63岁，平均年龄40.3岁，其中有梗阻性黄疸27例，术前检查GGT升高,术中胆道造影发现结右5例，经胆囊管胆道镜取出结右，所有病例术前均经彩超、CT检查发现胆囊多发结石，结石均较小（
