输卵管导管联合腹腔镜治疗胆总管结石的临床体会

Clinical experience of tubal catheter combined with laparoscopy in treatment of choledocholithiasis

摘要:

目的 探讨采用输卵管导管联合腹腔镜治疗胆总管结石的临床技巧。方法 回顾性分析该院2017年2月－2018年1月48例因胆总管结石行输卵管导管联合腹腔镜胆总管切开探查的患者的临床资料。结果 所有患者均在腹腔镜下成功取出并取尽胆总管内结石，一期胆总管缝合43例，放置T管引流5例；手术时间45～180 min，平均116 min。术后住院时间为6～14 d，平均8 d。术后发生胆瘘1例，保守引流9 d后痊愈；5例放置Ｔ管引流者，术后4～6周行Ｔ管造影，均无结石残留，拔除T管。术后随访3个月～１年，未见胆管狭窄及残留结石等情况发生。结论 输卵管导管联合腹腔镜治疗胆总管结石是安全、可行和有效的，娴熟的输卵管导管冲洗取石技巧、丰富的腹腔镜经验及术中细致的操作是手术成功的关键。

Abstract:

Objective To discuss the clinical skill of tubal catheter combined with laparoscopy in treatment of choledocholithiasis.Methods Retrospective analysis was performed using clinical data of 48 patients with choledocholithiasis were treated by tubal catheter combined with laparoscopic common bile duct exploration from Febrary 2017 to January 2018.Results All these patients were successfully removed and all common bile duct stones were removed under laparoscopy, 43 cases accepted primary suture and 5 cases accepted T tube drainage. The operation time was 45~180 min with the average operation of 116 min, the postoperative hospital stay was 6~14 d with the average of 8 d. Postoperative biliary leakage occurred in 1 cases, were treated conservatively and cured in 9 d. No postoperative residual calculi was confirmed by T-tube cholangiography in 4~6 weeks after surgery in 5 cases accepted T tube drainage, then the T tube was removed. All the patients were followed for three months to 1 year, and the residual stones and biliary stricture were not found.Conclusion Tubal catheter combined with laparoscopy in the treatment of choledocholithiasis is a safe, feasible and effective method. Master the methed how to use the tubal catheter to flush and remove the choledocholithiasis, rich experience in laparoscopy and careful operation are the key to successful operation.