CAJ | 학술논문

目的分析腹腔镜联合胆道镜治疗继发胆道结石的术后并发症。方法 105例患者依据检查结果采用2种不同的胆道探查方式：(1)胆囊结石合并胆道继发结石，胆囊管有明显扩张或经胆囊管扩张术可顺利通过胆道镜的患者，采用腹腔镜联合胆道镜经胆囊管胆道探查取石术(laparoscopic transcyctic common bile duct exploration，LTCBDE)，术后不放“T”管引流；(2)若胆囊管细且无扩张，或胆囊管存在变异，采用腹腔镜联合胆道镜胆总管切开胆道取石术( laparoscopic common bile duct exploration，LCBDE)。其中若胆道内结石较少，结石无嵌顿则一期缝合胆道且不放“T”管，术后放腹腔引流管。若胆道下端结石嵌顿取石过程困难，或结石多、取石时间长则放“T”管引流同时放腹腔引流管。结果共行LTCBDE+腹腔镜胆囊切除70例，LCBDE+腹腔镜胆囊切除35例，其中放T管14例，不放T管21例。术后腹腔积液17例，其中LTCBDE组6例，LCBDE组11例。胆汁性腹膜炎5例，LTCBDE组1例，LCBDE组4例。腹部疼痛13例，LTCBDE组4例，LCBDE组9例。体温增高11例，LTCBDE组3例，LCBDE组8例。以上并发症均经腹腔穿刺引流保守治疗痊愈。LCBDE组术后T管脱出2例，分别发生在术后当天和术后第2天，经再手术治愈。LCBDE组胆道残余结石14例，均经胆道镜完全取出；LTCBDE组随访43例，术后3个月复查B超未发现残余胆道结石。LTCBDE组中1例出现胆囊动脉夹脱落出血再次腹腔镜止血痊愈；LCBDE组术后放T管中有1例出现胆漏经腹腔引流10 d治愈。所有病例术后无胰腺炎发作。结论腹腔镜联合胆道镜治疗继发胆道结石可通过术前确切评估和术中正确处理避免或减少术后并发症的发生。
목적 분석복강경연합담도경치료계발담도결석적술후병발증。방법 105례환자의거검사결과채용2충불동적담도탐사방식：(1)담낭결석합병담도계발결석，담낭관유명현확장혹경담낭관확장술가순리통과담도경적환자，채용복강경연합담도경경담낭관담도탐사취석술(laparoscopic transcyctic common bile duct exploration，LTCBDE)，술후불방“T”관인류；(2)약담낭관세차무확장，혹담낭관존재변이，채용복강경연합담도경담총관절개담도취석술( laparoscopic common bile duct exploration，LCBDE)。기중약담도내결석교소，결석무감돈칙일기봉합담도차불방“T”관，술후방복강인류관。약담도하단결석감돈취석과정곤난，혹결석다、취석시간장칙방“T”관인류동시방복강인류관。결과 공행LTCBDE+복강경담낭절제70례，LCBDE+복강경담낭절제35례，기중방T관14례，불방T관21례。술후복강적액17례，기중LTCBDE조6례，LCBDE조11례。담즙성복막염5례，LTCBDE조1례，LCBDE조4례。복부동통13례，LTCBDE조4례，LCBDE조9례。체온증고11례，LTCBDE조3례，LCBDE조8례。이상병발증균경복강천자인류보수치료전유。LCBDE조술후T관탈출2례，분별발생재술후당천화술후제2천，경재수술치유。LCBDE조담도잔여결석14례，균경담도경완전취출；LTCBDE조수방43례，술후3개월복사B초미발현잔여담도결석。LTCBDE조중1례출현담낭동맥협탈락출혈재차복강경지혈전유；LCBDE조술후방T관중유1례출현담루경복강인류10 d치유。소유병례술후무이선염발작。결론복강경연합담도경치료계발담도결석가통과술전학절평고화술중정학처리피면혹감소술후병발증적발생。
Objective To study the complications after laparoscopic bile duct exploration.Methods Two approaches for bile duct exploration were used in 105 patients: (1) laparoscopic transcystic common bile duct exploration (LTCBDE) was used for patients with gallstones with choledocholithiasis and cystic duct dilation. No T tube was used for drainage, (2) Laparoscopic common bile duct exploration (LCBDE) was used for patients with gallstones with choledocholithiasis but without cystic duct dilation. The common bile duct was sutured primarily without T tube drainage in those patients with a small number of stones. T tube drainage was used in those patients with many stones or severe edema at the lower end of the common bile duct. Results We carried out LTCBDE+ LC in 70 patients and LCBDE+LC in 35 patients, 14 patients had T tube drainage and 21 patients had no T tubes in the latter group of patients. Postoperatively, there were ascites in 17 patients (LTCBDE 6 and LCBDE 11 ), biliary peritonitis in 5 patients (1 LTCBDE and 4 LCBDE), abdominal pain in 13 patients (LTCBDE 4 and LCBDE 9), and fever in 11 patients (LTCBD 3 and LCBDE 8). All the complications responded to conservative treatment. 14 patients in the LCBDE group had residual stones.Choledochoscopy was used to remove the residual stones. There was no pancreatitis. Conclusions Adequate preoperative workup, good clinical judgment and precise treatment skill help to reduce complication rates after operation for gallstones with choledocholithiasis.