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。.......
Objective To explore the clinical value of laparoscopy in the treatment of pancreatic diseases. Methods Twelve patients with pancreatic diseases received laparoscopic surgery. Among which 9 patients with cystic diseases, 4 cases underwent laparoscopic spleen-preserving distal pancreatectomy, 2 cases received distal pancreatectomy and splenectomy, and 3 cases underwent pancreatic cystectomy. Laparoscopic insulinoma enucleation was performed for 2 patients who suffered from insulinoma. Besides, a patient suffered from pancreatic carcinoma recurrence received left thoracoscopic splanchnicectomy. Results All the operations were accomplished successfully, including 8 total laparoscopic surgery and 4 laparoscopic assisted surgery. The average operative time was 225 min （range 100-420 min）, and the average volume of blood loss was 80 ml （range 2-150 ml）. Pancreatic fistula was observed in 1 patient which was cured by conservative therapy. The postoperative average hospital stay was 7.2 d （range 5-13 d）. The patient with recurrent pancreatic carcinoma survived for 6 months after operation and the pain-killing effect was satisfactory. With a follow-up of 10-36 months for other patients, the surgical effects were ideal and no recurrence occurred.Conclusion With the advantages of less trauma， less pain， fast recovery， and low morbidity rate, laparoscopic surgery is an effective and safe method for the treatment of pancreatic diseases, and thus may be widely used in the clinical settings in the future.