基层医学论坛
基層醫學論罈
기층의학론단
PUBLIC MEDICAL FORUM MAGAZINE
2013年
31期
4088-4089,4090
,共3页
胆囊结石%继发性胆管结石%腹腔镜%胆道镜%经胆囊管探查取石
膽囊結石%繼髮性膽管結石%腹腔鏡%膽道鏡%經膽囊管探查取石
담낭결석%계발성담관결석%복강경%담도경%경담낭관탐사취석
Cholecystolithiasis%Laparoscope%Secondary common bile duct stone%Choledochoscope%Transcystic common bile duct exploration
目的：总结腹腔镜联合术中胆道镜经胆囊管胆道探查取石术（laparoscopic transcystic common bile duct exploration with choledochoscope，LTCBDEC）的临床经验。方法对172例胆囊结石合并胆总管继发性结石或可疑病变患者，采用腹腔镜联合术中胆道镜经胆囊管胆道探查取石治疗。结果157例手术成功（91.2%），发现胆总管结石103例，阴性探查54例，7例改行腹腔镜胆总管切开取石T管引流术，5例改行腹腔镜胆总管切开探查Ⅰ期缝合术，3例中转开腹；平均手术用时95 min（65 min~240 min）。术后出现胆管残石2例，胆瘘7例，戳孔感染3例，出血1例。术后2d~5d拔除腹腔引流管，平均住院时间5.1d（4d~7d）。结论腹腔镜联合术中胆道镜经胆囊管胆道探查取石术微创、安全、有效，并发症发生率低，值得临床推广应用。
目的：總結腹腔鏡聯閤術中膽道鏡經膽囊管膽道探查取石術（laparoscopic transcystic common bile duct exploration with choledochoscope，LTCBDEC）的臨床經驗。方法對172例膽囊結石閤併膽總管繼髮性結石或可疑病變患者，採用腹腔鏡聯閤術中膽道鏡經膽囊管膽道探查取石治療。結果157例手術成功（91.2%），髮現膽總管結石103例，陰性探查54例，7例改行腹腔鏡膽總管切開取石T管引流術，5例改行腹腔鏡膽總管切開探查Ⅰ期縫閤術，3例中轉開腹；平均手術用時95 min（65 min~240 min）。術後齣現膽管殘石2例，膽瘺7例，戳孔感染3例，齣血1例。術後2d~5d拔除腹腔引流管，平均住院時間5.1d（4d~7d）。結論腹腔鏡聯閤術中膽道鏡經膽囊管膽道探查取石術微創、安全、有效，併髮癥髮生率低，值得臨床推廣應用。
목적：총결복강경연합술중담도경경담낭관담도탐사취석술（laparoscopic transcystic common bile duct exploration with choledochoscope，LTCBDEC）적림상경험。방법대172례담낭결석합병담총관계발성결석혹가의병변환자，채용복강경연합술중담도경경담낭관담도탐사취석치료。결과157례수술성공（91.2%），발현담총관결석103례，음성탐사54례，7례개행복강경담총관절개취석T관인류술，5례개행복강경담총관절개탐사Ⅰ기봉합술，3례중전개복；평균수술용시95 min（65 min~240 min）。술후출현담관잔석2례，담루7례，착공감염3례，출혈1례。술후2d~5d발제복강인류관，평균주원시간5.1d（4d~7d）。결론복강경연합술중담도경경담낭관담도탐사취석술미창、안전、유효，병발증발생솔저，치득림상추엄응용。
Objective To summarize clinical experience of Laparoscopic transcystic common bile duct exploration with choledochoscope(LTCBDEC) in treating common bile duct lithiasis. Methods LTCBDEC was applied for treating 172 cases cholecystolithiasis combined with diagnosed or suspicious secondary stone in common bile duct. Results 157 cases (91.2%) were undergone LTCBDEC, among which 102 patients were found actual stone in common bile duct while the other 54 cases with negative finding. Other than this, 7 cases were operated by laparoscopic common bile duct insection with"T"pipe drainage, while dissected common bile duct of other 5 patients were sutured during operation and 3 cases suffered open surgery. Statistically, the mean operation time was 95min (65 min~240 min). Postoperative complication included 2 cases of residual common bile duct lithiasis, 7 bile leakage, 3 cases portsite infection and 1 intra-abdominal hemorrhage. The post-operative stay was meanly 5.1 d (4 d~7 d) while drainage pipe extraction time ranged 2-5d after surgery. Conclusion The approach of LTCBDEC in treating common bile duct lithiasis is minimally invasive, safe, effective and has potential to expand its indication in clinical therapy.
