腹腔镜联合胆道镜经胆囊管治疗胆囊结石合并胆总管结石的临床分析

梁刚; 马富平; 何盟国

doi:10.3969/j.issn.1001-5256.2017.11.024

腹腔镜联合胆道镜经胆囊管治疗胆囊结石合并胆总管结石的临床分析

DOI: 10.3969/j.issn.1001-5256.2017.11.024

1. 陕西省核工业二一五医院肝胆外科
2. 咸阳市中心医院

详细信息

中图分类号: R657.42
计量
- 文章访问数: 1974
- HTML全文浏览量: 24
- PDF下载量: 376
- 被引次数: 0
出版历程
- 收稿日期: 2017-05-12
- 出版日期: 2017-11-20

Clinical analysis of laparoscopic combined with choledochoscope via the cystic duct for choledocholithiasis

Department of Hepatobiliary Surgery, Xianyang 215 Hospital of the Nuclear Industry in Shaanxi Province

摘要

摘要: 目的探讨应用腹腔镜联合胆道镜经胆囊管行胆道探查治疗胆囊结石合并胆总管结石的临床效果。方法对2014年1月-2015年12月陕西省核工业二一五医院收治的52例胆囊结石合并胆总管结石患者行腹腔镜联合胆道镜经胆囊管胆道探查取石术,观察其临床效果。结果 52例患者中40例顺利完成手术,手术成功率为76.92%。7例改为腹腔镜下胆总管切开取石、T管引流术,5例中转开腹行胆总管切开取石、T管引流术,中转开腹率9.62%。43例患者一次取石成功,占82.69%;剩余9例患者行二次取石,其中行经胆囊管胆道探查取石术者8例,行腹腔镜下胆总管切开取石术者1例。所有患者术后留置网膜孔引流管,术后310 d拔除,1例行腹腔镜下胆总管切开取石患者术后出现胆漏,经保守治疗后康复。无胆道出血、胆道感染等发生,平均住院时间（8.24±2.52）d,所有患者均得到随访1年,B超及磁共振胰胆管造影检查肝内外未见结石残留,肝功能胆红素指标正常。结论腹腔镜联合胆道镜经胆囊管进行胆道探查取石术具有创伤小、患者恢复快、并发症少、安全等优点,临床应用需严格掌握其适应证。
- 胆囊结石病 /
- 胆总管结石 /
- 腹腔镜检查 /
- 胆道镜 /
- 治疗
Abstract: Objective To explore the clinical application of laparoscopic transcystic common bile duct exploration.Methods From Jan2014 to Dec 2015, laparoscopic transcystic common bile duct exploration was performed in 52 cases of cholecystolithiasis.The therapeutic effects of cases were studied.Results Among them, 40 cases were performed operation successfully.The success rate of operation was 76.92%.7 cases were changed to laparoscopic common bile duct incision exploratory stone operation.5 cases were performed common bile duct incision nephrolithotomy, and the transfer rate was 9.62%.43 cases were toke stone success at a time in all of patients.The success removed rate was 82.69%.The last 9 patients included 8 cases performed laparoscopic transcystic common bile duct exploration and 1 case performed laparoscopic common bile duct incision exploratory stone operation.All cases were placed abdominal cavity drainage tube pulled out after 3-10 days.Biliary leakage occurred in 1 patients performed laparoscopic common bile duct incision exploratory stone operation, and it was cured after conservative treatment.No biliary tract infection, biliary tract bleeding complications occurred.The average hospitalization time was (8.24±2.52) days.All patients were followed up 1 year.No extrahepatic bile duct stones were found by B-ultrasonic and MRCP, and bilirubin were normal.Conclusion Laparoscopic transcystic common bile duct exploration has positive clinical efficacy with small trauma, quick rever, less complications, safety and effective.etc.But its indications must be grasped strictly in clinical promotion.
- cholecystolithiasis /
- choledocholithiasis /
- laparoscopy /
- choledochoscope /
- therapy

HTML全文

参考文献(13)

[1]YANG DX, YANG MW, ZHANG Y, et al.Clinical application of laparoscopy combined with choledochoscopy for treatment of gallstones with common bile duct stones in primary hospitals[J].J Clin Hepatol, 2014, 30 (11) :1132-1134. (in Chinese) 杨东晓, 杨明稳, 张勇, 等.腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石在基层医院的应用体会[J].临床肝胆病杂志, 2014, 30 (11) :1132-1134.

[2]YE ZD, HUANG D, WENG JF, et al.Application of combined laparoscopy and choledochoscopy in treatment of choledocholithiasis in patients over 80 years of age:therapeutic results and postoperative follow-up[J].Chin J Gen Surg, 2016, 25 (2) :298-301. (in Chinese) 叶志东, 黄迪, 翁杰锋, 等.80岁以上超高龄胆总管结石患者应用腹腔镜与胆道镜双镜联合手术疗效与术后随访[J].中国普通外科杂志, 2016, 25 (2) :298-301.

[3]SHANG XW.Comparative analysis of laparoscopic exploration of common bile duct via the cystic duct bile duct versus choledochotomy in the treatment of extrahepatic bile duct stones[J].Chin J Gen Surg, 2014, 23 (8) :1144-1146. (in Chinese) 尚修万.腹腔镜下经胆囊管胆道探查术与胆总管切开探查术治疗肝外胆管结石的疗效比较[J].中国普通外科杂志, 2014, 23 (8) :1144-1146.

[4]SUN M, LIU XQ, TENG YS, et al.Laparoscopic transcystic common bile duct exploration:A clinical analysis of 68 cases[J].Chin J Pract Surg, 2013, 33 (9) :776-777, 786. (in Chinese) 孙敏, 刘训强, 腾毅山, 等.腹腔镜下胆道镜经胆囊管胆道探查取石术68例临床分析[J].中国实用外科杂志, 2013, 33 (9) :776-777, 786.

[5]WEN ZQ, SONG Y, ZHANG YM, et al.Clinical application of laparoscopy combined with choledochoscopy and duodenoscopy in treatment of gallstones complicated by intra-and extrahepatic bile duct stones[J].J Clin Hepatol, 2016, 32 (6) :1145-1148. (in Chinese) 温治强, 宋越, 张耀明, 等.腹腔镜联合胆道镜、十二指肠镜治疗胆囊结石合并肝内外胆管结石的效果观察[J].临床肝胆病杂志, 2016, 32 (6) :1145-1148.

[6]WENNER DE, WHITWAM P, ROSSER J, et al.A stone extraction facilitation device to achieve an improved technique for performing LCBDE[J].Surg Endosc, 2005, 19 (1) :120-125.

[7]LI Y, WU Z, YAO YM, et al.Laparoscopic trans-cystic bile duct exploration in the management of choledocholithiasis[J].Chin JMin Inv Surg, 2016, 16 (1) :47-49. (in Chinese) 李宇, 仵正, 姚英民, 等.腹腔镜经胆囊管胆总管探查取石术的临床应用[J].中国微创外科杂志, 2016, 16 (1) :47-49.

[8]QU SX, MENG XD, FU QJ, et al.Vale of laparoscopic transcystic duct common bile duct exploration in patients of gallstones with secondary choledochotithiasis[J].J Hepatobiliary Surg, 2016, 24 (3) :217-218. (in Chinese) 屈顺喜, 孟晓东, 付庆江, 等.腹腔镜下经胆囊管取石治疗胆囊结石合并继发胆总管结石的临床价值[J].肝胆外科杂志, 2016, 24 (3) :217-218.

[9]REINDERS JS, GOUMA DJ, UBBINK DT, et al.Transcystic or transductal stone extraction during single-stage treatment of choledochocystolithiasis:a systematic review[J].World J Surg, 2014, 38 (9) :2403-2411.

[10]LEI HF.Effect comparison of laparoscopic transcystic common bile duct explo-ration and common bile duct incision exploration in the treatment of ex-trahepatic bile duct stone[J].China Med Herald, 2015, 12 (29) :89-92. (in Chinese) 雷海峰.腹腔镜下经胆囊管胆道探查术与胆总管切开探查术治疗肝外胆管结石的效果比较[J].中国医药导报, 2015, 12 (29) :89-92.

[11]WANG ZC, LUO H.Literature analysis of 1186 cases of laparoscopic transcystic common bile duct exploration[J].Chin J Gen Surg, 2012, 21 (8) :941-945. (in Chinese) 王舟翀, 罗浩.腹腔镜下经胆囊管途径胆总管探查手术1186例文献分析[J].中国普通外科杂志, 2012, 21 (8) :941-945.

[12]CHEN XM, ZHANG Y, CAI HH, et al.Transcystic approach with micro-incision of the cystic duct and its confluence part in laparoscopic common bile duct exploration[J].J Laparoendosc Adv Surg Tech A, 2013, 23 (12) :977-981.

[13]PENG Y, WANG LX, XU Z, et al.Laparoscope combined with choledochoscope for cholecystolithiasis and choledocholithiasis through a micro-incision at linking part of cystic duct[J].Chin J Min Inv Surg, 2015, 15 (3) :224-227. (in Chinese) 彭颖, 王立新, 徐智, 等.腹腔镜联合胆道镜经胆囊管汇入部微切开治疗胆囊结石合并胆总管结石[J].中国微创外科杂志, 2015, 15 (3) :224-227.

施引文献

资源附件(0)

访问统计