腹腔镜术；纤维胆道镜；胆总管探查术_

腹腔镜联合纤维胆道镜胆总管探查术21例分析

http://www.100md.com 《腹腔镜外科杂志》 1998年第1期

腹腔镜术；纤维胆道镜；胆总管探查术,,腹腔镜术；纤维胆道镜；胆总管探查术,【关键词】腹腔镜术；纤维胆道镜；胆总管探查术,1资料与方法,2结果,3讨论,参考文献：

     【摘要】目的：总结腹腔镜联合纤维胆道镜治疗胆囊结石合并肝外胆管结石的体会，评估“两镜”联合治疗胆石症的临床疗效。方法：回顾分析2002年2月至2006年6月行腹腔镜胆总管切开探查、纤维胆道镜取石、胆道扩张及T管引流术(laparoscopic choledochotomy Ttube drainage,LCTD)患者的临床资料。结果：21例中4例术前行ERCP+EST，手术成功20例，手术时间70～180min，平均120min，1例因术中病理示胆囊粘液腺癌，中转开腹行胆囊癌根治术。18例留置T管。患者术后第1天均可下床活动和进食，术后12d行T管造影夹闭T管。术后30～40d(平均34d)拔除T管，2例发生胆漏，其余病例无胆道狭窄、胆道出血和残余结石等手术并发症。1例术后2个月胆管结石复发经T管窦道取石。结论：腹腔镜胆总管探查术具有创伤轻、患者痛苦小、康复快、腹腔脏器干扰少等优点，同时能取得与开腹手术相同的治疗效果，是目前微创治疗胆囊结石并复杂性胆管结石较理想的方法。

    【关键词】腹腔镜术；纤维胆道镜；胆总管探查术

    Analysis of laparoscopy combined with fibercholangioscopic choledochotomy in 21 cases

    ZHANG Tao，LI Kejun.

    The First Affiliated Hospital of Dalian Medical University,Dalian 116011,China

    【Abstract】 Objective:To summarize the experiences of laparoscopy combined with fibercholangioscopy for the treatment of cholecystolithiasis and choledocholithiasis and evaluate the clinical curative effect of the method.Methods:The clinical data of 21 cases undergone laparoscopic choledochotomy and Ttube drainage were retrospectively analyzed.Results:Among 21 cases,4 patients were performed ERCP and EST preoperatively,and operations were succeeded in 20 cases.The operating time was 70180min(average,120 min).One case was converted to laparotomy because gallbladder mucinous adenocarcinoma was diagnosed by frozen pathological section.Ttube was indwelled in choledochus in 18 cases.Patients could get out of bed and take food on the first day after operation.Ttube visualization and occlusion could be performed in the 12th day,and Ttube was pulled out in 3040 days(average,34 days)after operation.Bile leakage was found in 2 cases,but no postoperative complications happened in the others,such as stenosis of the biliary tract,hematobilia and residual stone.Calculus of bile duct recurred in 1 case in 2 months after operation,and was removed by fibercholedochoscope through Ttube sinus tract.Conclusions:The laparoscopic choledochotomy has many advantages,such as minor damage,less suffering,rapid recovery and less dysfunction of visceral organs,and can achieve the same effects as laparotomy,and is a better minimally invasive treatment for cholecystolithiasis and complicated choledocholithiasis. ......

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