Laparoscopic Treatment for Calculus of Intra- and Extrahepatic Duct_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

胡三元

Corresponding author：

Keywords：

胆管结石; 腹腔镜; 并发症

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

肝内、外胆管结石是常见病，治疗以外科手术为主。传统开放手术治疗疾病的同时，对患者创伤亦大。随着腹腔镜、胆道镜以及十二指肠镜技术的日益成熟，许多原本需要开腹处理的肝内、外胆管结石可用微创手术治疗，现就腹腔镜联合治疗肝内、外胆管结石的几种手术方式及其常见并发症探讨如下。
1　腹腔镜胆总管探查术(laparoscopic common bile duct exploration)
腹腔镜胆囊切除术(LC)初期，胆囊结石并胆总管结石一般选择分期处理，即采用LC前或后行内镜括约肌切开取石术(EST)的办法，这种分期手术避免了开腹胆总管探查，但其缺点也显而易见：据文献\[1\]报道，即便对有经验的内镜医师而言，EST仍有5%～19%的并发症发生率和1.3%的死亡率，而且EST的应用显著增加了患者的费用; 对年轻患者尚需长期随诊观察EST后乳头括约肌的功能状况。腹腔镜胆总管探查术为处理胆囊结石并胆总管结石提供了新的选择。目前多数学者认为,EST除明确应用于术后发现胆总管结石的病例外，术前及术中发现的胆总管结石病例以行腹腔镜胆总管探查术为宜\[2\]。腹腔镜胆总管探查术有两种途径: 经胆囊管或胆总管切开探查取石，后者又根据T管放置与否分为T管引流术和一期缝合术。.......

Citation： 胡三元. Laparoscopic Treatment for Calculus of Intra- and Extrahepatic Duct. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2008, 15(10): 711-713. doi: Copy

1.	Petelin JB. Laparoscopic common bile duct exploration [J]. Surg Endosc, 2003; 17(11)∶1705.
2.	Hungness ES, Soper NJ. Management of common bile duct stones [J]. J Gastrointest Surg, 2006; 10(4)∶612.
3.	Lyass S, Phillips EH. Laparoscopic transcystic duct common bile duct exploration [J]. Surg Endosc, 2006; 20 Suppl 2∶S441.
4.	Phillips EH, Carroll BJ. New techniques for the treatment of common bile duct calculi encountered during laparoscopic cholecystectomy [J]. Prob Gen Surg, 1991; 8(3)∶387.
5.	Decker G, Borie F, Millat B, et al. One hundred laparoscopic choledochotomies with primary closure of the common bile duct [J]. Surg Endosc, 2003; 17(1)∶12.
6.	Ha JP, Tang CN, Siu WT, et al. Primary closure versus T-tube drainage after laparoscopic choledochotomy for common bile duct stones [J]. Hepatogastroenterology, 2004; 51(60)∶1605.
7.	Tang CN, Tai CK, Ha JP, et al. Antegrade biliary stenting versus T-tube drainage after laparoscopic choledochotomy——a comparative cohort study [J]. Hepatogastroenterology, 2006; 53(69)∶330.
8.	胡三元，陈波，王可新，等. 开腹胆道手术后腹腔镜胆道再手术29例分析 [J]. 中华普通外科杂志， 2007; 22(1)∶46.
9.	段伦喜, 钟德玲, 苗雄鹰, 等. 肝切除联合纤维胆道镜治疗肝胆管结石临床分析 [J]. 中华普通外科杂志, 2006; 21(3)∶164.
10.	江文枢, 卢榜裕, 蔡小勇, 等. 腹腔镜肝切除治疗肝内胆管结石 [J]. 中国内镜杂志, 2006; 12(1)∶21.
11.	陈平, 别平, 刘吉奎, 等. 腹腔镜下规则左半肝切除治疗肝内胆管结石二例 [J]. 中华外科杂志， 2003; 41(10)∶737.
12.	王可新, 张海峰, 胡三元. 腹腔镜肝脏切除术断肝方法的研究进展 [J]. 腹腔镜外科杂志， 2003; 8(4)∶251.
13.	胡三元. 腹腔镜胆总管切开取石术的并发症及其防治 [J]. 医师进修杂志(外科版), 2004; 27(7)∶7.
14.	Hunter JG, Soper NJ. Laparoscopic management of bile duct stones [J]. Surg Clin North Am, 1992; 72(5)∶1077.
15.	胡三元, 亓玉忠, 张建良, 等. 腹腔镜胆总管切开取石T 管引流术后少见并发症3例报告 [J].中华消化内镜杂志, 2000; 17(5)∶314.

1. 　 Petelin JB. Laparoscopic common bile duct exploration [J]. Surg Endosc, 2003; 17(11)∶1705.
2. 　Hungness ES, Soper NJ. Management of common bile duct stones [J]. J Gastrointest Surg, 2006; 10(4)∶612.
3. 　 Lyass S, Phillips EH. Laparoscopic transcystic duct common bile duct exploration [J]. Surg Endosc, 2006; 20 Suppl 2∶S441.
4. 　Phillips EH, Carroll BJ. New techniques for the treatment of common bile duct calculi encountered during laparoscopic cholecystectomy [J]. Prob Gen Surg, 1991; 8(3)∶387.
5. 　Decker G, Borie F, Millat B, et al. One hundred laparoscopic choledochotomies with primary closure of the common bile duct [J]. Surg Endosc, 2003; 17(1)∶12.
6. 　Ha JP, Tang CN, Siu WT, et al. Primary closure versus T-tube drainage after laparoscopic choledochotomy for common bile duct stones [J]. Hepatogastroenterology, 2004; 51(60)∶1605.
7. 　Tang CN, Tai CK, Ha JP, et al. Antegrade biliary stenting versus T-tube drainage after laparoscopic choledochotomy——a comparative cohort study [J]. Hepatogastroenterology, 2006; 53(69)∶330.
8. 　胡三元，陈波，王可新，等. 开腹胆道手术后腹腔镜胆道再手术29例分析 [J]. 中华普通外科杂志， 2007; 22(1)∶46.
9. 　段伦喜, 钟德玲, 苗雄鹰, 等. 肝切除联合纤维胆道镜治疗肝胆管结石临床分析 [J]. 中华普通外科杂志, 2006; 21(3)∶164.
10. 　江文枢, 卢榜裕, 蔡小勇, 等. 腹腔镜肝切除治疗肝内胆管结石 [J]. 中国内镜杂志, 2006; 12(1)∶21.
11. 　陈平, 别平, 刘吉奎, 等. 腹腔镜下规则左半肝切除治疗肝内胆管结石二例 [J]. 中华外科杂志， 2003; 41(10)∶737.
12. 　王可新, 张海峰, 胡三元. 腹腔镜肝脏切除术断肝方法的研究进展 [J]. 腹腔镜外科杂志， 2003; 8(4)∶251.
13. 　胡三元. 腹腔镜胆总管切开取石术的并发症及其防治 [J]. 医师进修杂志(外科版), 2004; 27(7)∶7.
14. 　Hunter JG, Soper NJ. Laparoscopic management of bile duct stones [J]. Surg Clin North Am, 1992; 72(5)∶1077.
15. 　胡三元, 亓玉忠, 张建良, 等. 腹腔镜胆总管切开取石T 管引流术后少见并发症3例报告 [J].中华消化内镜杂志, 2000; 17(5)∶314.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Laparoscopic Treatment for Calculus of Intra- and Extrahepatic Duct

Abstract Full text Figures/Tables Video References Cited by

Format

Content