两镜联合辅助小切口治疗肝内外胆管结石的临床研究.docVIP

精品论文 参考文献 两镜联合辅助小切口治疗肝内外胆管结石的临床研究 陈曹臻 陈春雷 曾瑜（广东省湛江市第二人民医院广东湛江524000） 【摘要】目的： 探讨两镜联合（腹腔镜、纤维胆道镜）辅助小切口治疗肝内外胆管结石的适应症、手术方法和临床效果；方法： 回顾33例患者利用腹腔镜、纤维胆道镜辅以3-5cm小切口行胆囊切除、胆总管切开取石T管引流术。结果： 33例肝内外结石患者均在两镜联合辅助小切口下完成手术，无一例因特殊情况中止腹腔镜手术转为传统开腹（大切口）手术。平均手术时间90min，术后1-2天进食流质及下床活动，4-7天出院，无一例出现胆瘘、出血等并发症。讨论： 两镜联合辅助小切口的手术方式，扩大了微创腔镜手术的适应症，解决了复杂肝内外胆管结石的各种手术难点。 【关键词】腹腔镜；纤维胆道镜；小切口；胆总管切开取石T管引流 【Abstract】 Objective: To investigate the indication,Surgical methods, clinic results of Surgical Treatment with Combination of Endoscope (Laparoscopic and Choledochofiberscope) assisted by mini-incision for Intrahepatic and Extrahepatic Bili Duct Stone Disease; Methods: The clinical data of 33 case with Cholecystectomy ,Choledocholithotomy and T-tube Drainage by Combination of Endoscope (Laparoscopic and Coledochofiberscope) assisted by mini-incision(3-5 cm) were analyzed etrospectively. Results: All the minimally invasive surgery were successfully performed and no one were converted to Conventional Operation (large incision). The mean operation time was 90 minutes. The patients could act on floor and take liquid food after 1-2 days,and leave in 4-7 days.Complications were no cases of biliary fistula, Hemobilia and so on.Conclution: the surgical procedure of Combination of Endoscope assisted by mini-incision expands the indications of minimally invasive endoscope operation,and solves the difficulties of surgery for complex Intrahepatic and Extrahepatic Bili Duct Stone Disease 【Key words】Laparoscopic,Choledochofiberscope,mini-incision, Choledocholithotomy and T-tube Drainage 【中图分类号】R156.3【文献标识码】B【文章编号】1005-0515(2011)12-0382-02 腹腔镜胆总管切开联合纤维胆道镜取石、T管引流术（LCHTD）是继腹腔镜胆囊切除术（LC）后腹腔镜胆道外科的又一次飞跃［1］，但单纯两镜联合（腹腔镜、纤维胆道镜）四孔法行肝内外胆管结石治疗有一定局限性，如术中结石过大、过多、嵌顿或位于Ⅱ级胆管以上结石导致结石残留，标本取出困难，手术操作时间较长增大手术麻醉风险，术后胆瘘，胆道出血，T管脱落等并发症发生率较高，但经我们辅以3-5cm的小切口，很好的解决了以上的手术难点，减少并发症的发生，效果显著。2008年1月至2010年12月，我院共施行两镜联合辅助小切口治疗肝内外胆管结石33例，疗效满意。 1资料与方法 1.1临床资料:2008年1月至2010年12月我们利用两镜联合辅助小切口治疗肝内外胆管结石，主要诊断依据为超声、CT，术前诊断为急性或慢性胆囊炎合并肝内外胆管