目的:总结应用腹腔镜联合胆道镜治疗胆总管结石的体会。方法:回顾分析2003年1月至2009年5月成都市第五人民医院联合应用腹腔镜胆道镜治疗胆总管结石的临床资料。结果:经胆囊颈管取石成功21例,切开胆总管取石27例,其中胆总管I期缝合17例,T管引流31例,3例术后发生胆总管残余结石,经T管窦道胆道镜取石治愈,5例中转开腹。结论:选择合适病例,腹腔镜联合胆道镜治疗胆总管结石患者创伤小,效果好,且安全可靠。
Objective To evaluate the safety and efficacy of primary closure (PC) and T-tube drainage (TD) after laparoscopic common bile duct exploration (LCBDE). Methods The randomized controlled trials of PC and TD after LCBDE were retrieved from the Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until April 2015. All calculations and statistical tests were performed using ReviewerManager 5.2 software. Results Both of the two groups had no postoperative deaths within 30 days. The operative time and hospital stay of PC gourp were shorter than TD group statistically〔OR=–24.76, 95CI (–29.21, –20.31),P<0.000 01〕and〔OR=–2.68, 95%CI (–3.69, –1.67),P<0.000 01〕. The reoperative rate of PC group was lower than that of TD group, and the difference was statistically significant〔OR=0.20, 95%CI (0.05, 0.81),P=0.02〕. There was no significant difference between the two groups in the occurrence of postoperative severe complications〔OR=0.54, 95%CI (0.26, 1.12),P=0.10〕. Conclusions Compared with the TD group, the operative time and hospitalization time are shorer in PC group, and complication rate is similar, but the cost of treatment of the TD group is higher than PC group, so after LCBDE a primary closure of common bile duct is safe and effective method.
ObjectiveTo investigate the efficacy and safety of laparoscopic cholecystectomy and common bile duct exploration(LCBDE) with biliary stent drainage or T tube drainage. MethodsThe clinical data of 68 cases of gallbladder and bile duct stones with the LCBDE by the same surgeon in our hospital from June 2008 to June 2013 were retrospectively analyzed. Twenty-two patients were treated with LCBDE and biliary stent drainage(stent drainage group), 46 patients were treated with LCBDE and T tube drainage(T tube drainage group). ResultsThe operation were successfully completed of 2 groups. The anal exhaust time, peritoneal drainage time, postoperative hospitalization time, and hospital expenses in stent drainage group were shorter or less than thoes T tube drainage group(P < 0.05). There were no significant difference in the operative time, postoperative bilirubin level, and incidences of postoperative complications between the two groups(P > 0.05). ConclusionsThe stent drainage and T tube drainage after LCBDE has its own indications. Laparoscopic common bile duct exploration and biliary stent drainage is superior to the laparo-scopic common bile duct exploration and T tube drainage.
目的 总结开展腹腔镜下经胆囊管胆总管探查取石的手术技巧及应用体会。方法 回顾性分析笔者所在医院肝胆外科2010年7月至2012年12月期间行腹腔镜经胆囊管胆总管探查取石术的36例患者的临床资料。结果 30例病例经胆道探条扩张胆囊管后直接完成网篮取石，3例经胆囊管汇入胆总管处微切开完成取石，3例经胆道镜联合激光碎石完成手术。全组病例的手术时间为（110.88±25.99） min，术后住院时间为（6.59±1.18） d，均无严重操作相关并发症发生。结论 腹腔镜下经胆囊管胆总管探查取石术是安全可行的，若能综合各种技术，可提高手术的成功率。
【摘要】 目的 探讨腹腔镜胆总管探查一期缝合的可行性和适应证及临床价值。 方法 回顾性分析2007年7月—2010年10月72例胆管结石患者的临床资料，采用三孔法腹腔镜胆总管探查术，术中胆道镜配合胆道手术器械取石，一期缝合胆总管进行治疗。 结果 72例手术均获成功，无中转开腹，4例出现术后胆漏，经腹腔引流3~5 d治愈，无严重并发症。术后住院4~7 d（平均4.4 d）。72例均获随访，随访时间1~24个月（平均10个月）。术后1个月B型超声，未发现胆道狭窄及残余结石。 结论 腹腔镜胆总管探查术后一期缝合胆总管，安全、有效、微创效果显著，是临床微创治疗胆囊结石合并胆管结石的一种理想术式，值得临床推广应用。其关键是术中取尽结石和把握适应证，同时需要术者熟练掌握胆道镜技术及腹腔镜下胆总管切开缝合、打结等技术。【Abstract】 Objective To discuss the feasibility, indications and clinical value of laparoscopic common bile duct exploration with primary suture. Methods We analyzed the clinical data of 72 patients with biliary duct stone treated from July 2007 to October 2010. Three-port laparoscopic common bile duct exploration with primary suture was adopted; choledochoscopy and open bile duct operation instruments were used to take out the stones during the operation; and the common bile duct was treated with primary suture after operation. Results All operations were carried out successfully without any case of conversion to open operation. Bile leakage occurred in four cases and was cured with abdominal drainage tube for three to five days without any severe complications. Postoperative hospitalization time ranged from four to seven days, averaging at 4.4 days. All patients were followed up for one to 24 months (averaging at 10 months). B-mode ultrasonography examination one month after operation showed no biliary tract stricture or residual stone. Conclusions Laparoscopic common bile duct exploration with primary suture is safe, reliable, minimally invasive, more effective, and can be regarded as an ideal operative method for the treatment of cholecystolithiasis combined with biliary duct stone in clinical practices. It is worth popularizing. The key elements for a successful operation lie in completely taking out the stones and having a sound knowledge of indications. Furthermore, surgeons should master the skills in choledochoscopy techniques, laparoscopic incision, suture and ligation.
Objective To study the effect of laparoscopic common bile duct exploration via choledochotomy and T tube drainage. Metheods Laparoscopic exploration of common bile duct with choledochoscopy via choledochotomy was performed in 105 patients, T tube was placed in all patients with laparoscopic suturing technique.Results Except negative exploration in 2 cases, duct clearance was achieved in 99 per cent (102/103) of patients. Conclusion Laparoscopic exploratoin of common bile duct via choledochotomy and T tube drainage is one of the safe and effective management options for common bile duct calculi.
目的 探讨腹腔镜胆总管切开取石术的优势，总结手术操作经验及常见并发症的预防与处理。方法回顾性分析我院1999年6月至2010年4月期间收治的108 例胆管结石患者行腹腔镜胆总管探查取石术的手术方法、操作要点及并发症的处理。结果 腹腔镜手术成功 105例, 中转开腹3例; 手术时间（120±20） min,出血量（25±5） ml,住院时间（9±1） d; 术后发生胆道出血3例,漏胆7 例,残余结石6 例; 全组无死亡病例。结论 腹腔镜胆总管切开取石术具有创伤小、痛苦轻、恢复快、对腹腔脏器干扰小、住院时间短等优点，值得临床推广。
Objective To investigate the feasibility and patient selection of T-tube free laparoscopic common bileduct exploration through mini-incision in confluence of common bile duct （CBD） and cystic duct. Methods The clinical data of 52 patients who underwent CBD exploration from January 2009 to December 2011 were retrospectively analyzed. A 3-4mm longitudinal incision of anterior wall of CBD was made along the confluence of CBD and cystic duct， and then the choledochoscope was inserted into CBD through this mini-incision for the exploration and treatment by laparoscopy and choledochoscopy， the incision was sewed up by T-tube free primary suture. Results All 52 cases were cured and stone clearance rate was 100% as revealed by choledochoscopy and cholangiography. The time of operation， intraoperativecholangiography， removal of stones with help of choledochoscope， and removal drainage tube after operation was from 90 to 200 min with an average of 100min， 3 to 10min with an average of 6min， 5 to 15 min with an average of 8 min，and 3-5d with an average of 3.5d ， respectively. The drainage flow was 20-60mL/d with an average of 30mL/d. No biliary leakage， abdominal pain， and choloplania or infection of incision was observed following operation. The hospital stay was 5 to 12d with an average of 6.5d after operation. No calculus regeneration or bile duct stricture occurred during following-up of 3 to 40 months with an average of 20 months. Conclusion With proper patient selection， T-tube free laparoscopic CBD exploration through mini-incision in confluence of CBD and cystic duct is safe and feasible by proficient surgeons in laparoscopy and choledochoscopy.
Objective To discuss the therapeutic effect and safety of laparoscopic cholecystectomy plus laparoscopiccommon bile duct exploration （LC＋LCBDE） and endoscopic retrograde cholangiopancreatography/endoscopic sphincte-rotomy plus LC （ERCP/EST＋LC） for cholecystolithiasis with choledocholithiasis patients with obstructive jaundice. Methods The clinical data of cholecystolithiasis with choledocholithiasis patients with obstructive jaundice from January2011 to June 2012 were analyzed retrospectively. During this period， 48 patients were treated by LC＋LCBDE （LC＋LCBDE group）， and 76 patients by ERCP/EST＋LC （ERCP/EST＋LC group）. Results ①There were no statistical significances in the age， gender， preoperative total bilirubin， alanine aminotransferase， number and maximum diameter of common bile duct stone， and internal diameter of common bile duct in two groups （P＞0.05）. ②No perioperative mortality occurred and no significant differences were observed in terms of stone clearance from the common bile duct， postoperative morbidity， and conversion to open surgery in two groups （P＞0.05）. However， the operative time and post-operative hospital stay in the LC＋LCBDE group were shorter than those in the ERCP/EST＋LC group （P＜0.05）. In addi-tion， the costs of surgical procedure and hospitalization charges in the LC＋LCBDE group were less than those in the ERCP/EST＋LC group （P＜0.05）. Conclusions Both LC＋LCBDE and ERCP/EST＋LC are safe and effective therapies forcholecystolithiasis with choledocholithiasis patients with obstructive jaundice. However， LC＋LCBDE is better for pati-ents’ recovery and cost effective. Especially for patients with common bile duct＞1.0cm in diameter or with multiple common bile duct stones， LC＋LCBDE is the best choice. To sum up， the choice of minimally invasive treatment must be individualized according to the patient’s condition and the availability of local resources.