腹腔镜胆总管低位切开治疗胆总管下段嵌顿结石

摘要

目的 探讨腹腔镜胆总管低位切开取石治疗胆总管下段嵌顿结石的手术方法和技巧. 方法 回顾性分析我院2004年1月~2016年2月91例胆总管下段结石嵌顿的临床资料,均腹腔镜下胆总管低位切开,取石钳取石,留置T管.结果 79例术中取净结石,术后3~5周拔T管;12例术后残留结石,术后6~7周经胆道镜取石,拔T管.无医源性胆管、胰腺、十二指肠损伤.随访1个月~12年,中位随访时间4年,无反流性胆管炎,5例胆总管结石复发. 结论 腹腔镜胆总管十二指肠后段低位切开,结合取石工具,能较好地治疗胆总管下段嵌顿结石,是一种行之有效的手术方法.%Objective To investigate the surgical method and technique of laparoscopic low-position incision at common bile duct in the treatment of common bile duct stone incarceration.Methods A retrospective analysis was made based on the clinical data of 91 cases of patients with common bile duct stone incarceration from January 2004 to February 2016.All the patients underwent laparoscopic low-position incision at common bile duct, and the stones were removed with iithotomy forceps followed by T-tube indwelling.Results Out of the 91 patients, stones were completely taken out intraoperatively in 79 cases, with T-tubes removed 3-5 weeks after operation.Residual stones were found in 12 patients and were removed by choledochoscopy at 6-7 weeks postoperatively, together with T-tube removal.There were no iatrogenic bile duct or pancreatic and duodenal injuries.The follow-ups for 1 month to 12 years (median, 4 years) found no regurgitation cholangitis and 5 cases of recurrence of stones.Conclusion A laparoscopic low-position incision at posterior duodenum of common bile duct combined with stone removal is an effective method for the treatment of common bile duct stone incarceration.