【摘要】 目的探讨在腹腔镜胆总管切开胆管镜探查取石术中采用腹腔镜下经腹顺行推进法T管双导管(T形管+2根裁剪后的鼻胆管导管)捆绑支撑引流术(LCTBS)联合治疗胆囊结石、胆总管结石、合并的十二指肠乳头部梗阻或狭窄的应用体会。方法回顾性分析2001年4月至2018年6月期间符合入选标准的45例患者的临床资料。结果本组45例患者行胆囊切除术、行胆总管切开胆管镜取石术,必要时行冲击波碎石术。预先行逐级导管乳头扩张术、后行T形管+双导管支撑引流术86.7%(39/45),行逐级导管联合球囊导管乳头扩张术、T形管+双导管支撑引流术4.4%(2/45),行乳头扩张术失败而改为内镜乳头切开术、T形管+双导管支撑引流术6.7%(3/45),双导管支撑引流放置失败而改为T管引流术2.2%(1/45)。无残余结石。胆漏1例(2.2%)。经T管瘘道拔除双导管支撑引流管无失败病例。术后无肠穿孔和胆管穿孔,无大出血,无重症胰腺炎,无非计划再次手术病例,无死亡病例。手术并发症发生率为2.2%(1/45)。结论从本文有限病例进行初步研究发现,只要病例选择合适,LCTBS治疗胆囊结石、胆总管结石、合并十二指肠乳头部梗阻或狭窄是可行、有效和安全的。更多还原

【Abstract】 Objective To explore the surgical technique and clinical effect of laparoscopic T tube+double biliary catheter bundling and supporting drainage(LCTBS) of transabdominal consequent propulsive guidance technology for the treatment of extrahepatic bile duct stones with obstruction and stenosis of papillory during the course of therapeutic laparoscopy. Methods Clinical data of 45 patients who met the inclusion criteria between April 2001 and June 2018 were retrospectively analyzed. Results It was in 45 cases removed the gallbladder and exploration of common bile duct by laparoscopy. Step by step dilatable catheter expanded duodenal papilla and indwelling T tube and double biliary catheter drainage was in 86.7%(39/45); step by step dilatable catheter combining balloon catheter expanded duodenal papilla and indwelling T tube and double biliary catheter drainage was in 4.4%(2/45); with duodenoscopic papillary sphincterotomy and indwelling T tube and double biliary catheter drainage due to residual stenosis of duodenal papilla was used in 6.7%(3/45); with indwelling T shape tube drainage due to place the double biliary catheter drainage result in failure was used in 2.2%(1/45). Residual stone was not occurred. Bile leakage was cured in one case(2.2%). There were no failed cases through the T tube fistula pull T tube and double biliary catheter support drainage. No cases had perforation of intestine and bile duct, bleeding, acute pancreatitis. No death. Total postoperative complication formation rate was in 2.2%(1/45).Conclusion From preliminary results of limited cases in our hospital, if patients are suitable, LCTBS for treatment of the extrahepatic bile duct stones with obstruction and stenosis of papillory is safe and effective.更多还原