Gurbuz A T, Watson D, Fenoglio M E
Department of Surgery, Saint Joseph Hospital Medical Center, Denver, Colorado, USA.
Am Surg. 1999 Mar;65(3):212-4.
Laparoscopic cholecystectomy has become the gold standard for treatment of patients with symptomatic cholelithiasis. Management of common bile duct stones in the era of laparoscopy is an area of controversy. Although perioperative endoscopic retrograde cholangiography remains as a widely used procedure, experience is accumulating on the exploration of the common bile duct with the laparoscope. A biliary drainage procedure is indicated in selected patients with choledocholithiasis. Initially described by Reidel in 1892, side-to-side choledochoduodenostomy has become a popular biliary-enteric anastomosis technique in the last century. We describe two patients with recurrent choledocholithiasis and biliary obstruction due to benign biliary strictures. Both patients underwent laparoscopic common bile duct exploration and stone extraction. A side-to-side choledochoduodenostomy is then performed laparoscopically as a drainage procedure. Laparoscopic choledochoduodenostomy resulted in resolution of jaundice and relief of biliary obstruction. Laparoscopic choledochoduodenostomy can be an acceptable alternative to the open choledochoduodenostomy. In addition to a tension-free anastomosis and an adequate-sized stoma, intracorporeal suturing and knot-tying skills are also essential to the success of this procedure.
腹腔镜胆囊切除术已成为有症状胆结石患者治疗的金标准。腹腔镜时代胆总管结石的处理是一个有争议的领域。虽然围手术期内镜逆行胆管造影仍是一种广泛应用的操作，但腹腔镜探查胆总管的经验也在不断积累。对于部分胆总管结石患者，需行胆道引流术。1892年由赖德尔首次描述的胆总管十二指肠侧侧吻合术，在上个世纪已成为一种常用的胆肠吻合技术。我们描述了两名因良性胆管狭窄导致复发性胆总管结石和胆道梗阻的患者。两名患者均接受了腹腔镜胆总管探查及取石术。然后通过腹腔镜进行胆总管十二指肠侧侧吻合术作为引流手术。腹腔镜胆总管十二指肠吻合术使黄疸消退，胆道梗阻缓解。腹腔镜胆总管十二指肠吻合术可成为开放性胆总管十二指肠吻合术的一种可接受替代方案。除了无张力吻合和足够大小的吻合口外，体内缝合和打结技术对该手术的成功也至关重要。
