胆道镜联合应用在腹腔镜胆总管切开取石一期缝合中的作用

目的探讨胆道镜联合应用在腹腔镜胆总管切开取石一期缝合中的应用价值。方法总结2009年1月至2013年4月，腹腔镜胆总管切开取石一期缝合术61例的临床经验，胆总管直径≥8mm，腹腔镜下胆总管切开，用纤维胆道镜联合胆道直镜行胆总管取石，先用纤维胆道镜探查胆总管、肝总管及左右肝管，吸引器接输血器管反复冲洗胆总管，大部分结石可以被冲出，再用胆道镜检查，用取石网篮取出残余结石，若遇结石嵌顿或大的结石难以用纤胆镜取出时改用胆道直镜碎石、取石。结果61例患者成功行胆总管切开取石一期缝合术，用胆道直镜碎石取石29例，占47．5％；其中17例结石在胆总管下端嵌顿，12例因结石大难以取出。少量胆漏5例，引流量每天10～50m1，术后3～12d拔除腹腔引流管；手术时间90～180（134±22）min。术后住院7～14（8．4±1．5）d，所有患者均治愈。61例中有58例获随访，随访时间4～52个月，无残余结石。结论胆道直镜可以弥补纤维胆道镜的不足，胆道镜的联合应用可以尽可能取净结石，在腹腔镜胆总管切开取石一期缝合中发挥重要的作用。

The application value of fiber choledochoscope and straight choledochoscope joint application in primary closure of the common duct wound after the completion of gallstone extraction

Abstract] Objective To study the application value of fiber choledochoscope and straight choledochoscope joint application in primary closure of the common duct wound after the completion of gallstone extraction. Methods Summarizing clinical experience of 61 cases of primary closure of the common duct wound after the completion of gallstone extraction during January 2009 to Apirl 2013. Common bile duct diameter is ~8 mm. Incisioning common bile duct under laparoscopic,and removing calculus with fiber choledochoscope and straight choledochoscope. First,search common bile duct,common hepatic duct,left and right hepatic duct with fiber choledochoscope; Second, douching common bile duct repeatedly with aspirator which joints blood transfusion apparatus.Most calculus will be rushed out. Checking up biliary tractagain with the choledochoscope,using netting basket to take out residuary calculus.If there is calculus incarcerating or large calculus,it is difficult to take out calculus with fiber choledoehoscope, Switching to straight choledoehoscope to broken stone and remove the calculus. Results Sixty-one patients had surgical excisions which is primary closure of the common duct wound ？after the completion of gallstone extraction succeedly. Among 61 patients, 29patients using straight choledochoscope to broken stone and remove calculus,which is occupying 47.5%.Among 29 patients, 17patients＇ calculus incarcerating to the lower common bile duct, other 12patients＇ calculus is too large to take out. 5 patients appear postoperative little bile fistula, 10 m1-50 ml everday,remove the drainage tube during postoperation 3 days tol2days, Time of operation is 90-180 （134±22）min. All the patients are cured during postoperation 7 and 14 days.Among 61patients,58patients obtain follow-up visit, time is 4-52 months, without residual calculus. Conclusions Straight choledochoscope can make up shortage of fiber choledochoscope, combined application of choledochoscope （＇,an take out the calculus as far as possible,it is important to primary closure of the common duct wound after the completion of gallstone extraction.