Shimizu Shuji, Yokohata Kazunori, Mizumoto Kazuhiro, Yamaguchi Koji, Chijiiwa Kazuo, Tanaka Masao
Department of Endoscopic Diagnostics and Therapeutics, Kyushu University Faculty of Medicine, Fukuoka 812-8582, Japan.
J Hepatobiliary Pancreat Surg. 2002;9(2):201-5. doi: 10.1007/s005340200019.
In the era of laparoscopic surgery, treatment strategies for common bile duct stones remain controversial. Laparoscopic choledochotomy is usually indicated only when transcystic duct exploration is not feasible. However, laparoscopic choledochotomy provides complete access to the ductal system and has a higher clearance rate than the transcystic approach. In addition, primary closure of the choledochotomy with a running suture and absorbable clips facilitates the procedure. Therefore, to avoid postoperative biliary stenosis, all patients with bile duct stones can be indicated for choledochotomy, except for those with nondilated common bile duct. Placement of a C-tube also provides access for the clearance of possible retained stones by endoscopic sphincterotomy as a backup procedure. C-tube placement, in contrast to T-tube insertion, is advantageous in terms of a relatively short hospital stay. In conclusion, laparoscopic choledochotomy with C-tube drainage is recommended as the treatment of choice for patients with common bile duct stones.
在腹腔镜手术时代,胆总管结石的治疗策略仍存在争议。腹腔镜胆总管切开术通常仅在经胆囊管探查不可行时才适用。然而,腹腔镜胆总管切开术能完全进入胆管系统,且清除率高于经胆囊管途径。此外,用连续缝合和可吸收夹对胆总管切口进行一期缝合可简化手术过程。因此,为避免术后胆管狭窄,除胆总管未扩张的患者外,所有胆总管结石患者均可考虑行胆总管切开术。放置C管还可为内镜括约肌切开术清除可能残留的结石提供途径,作为备用程序。与放置T管相比,放置C管在缩短住院时间方面具有优势。总之,推荐采用腹腔镜胆总管切开术并置C管引流作为胆总管结石患者的首选治疗方法。
J Hepatobiliary Pancreat Surg. 2002
Hepatogastroenterology. 2004
J Hepatobiliary Pancreat Surg. 2002
Hepatogastroenterology. 2006
Eur J Surg. 1998-5
Gastroenterol Clin Biol. 2000-4
Zhonghua Wai Ke Za Zhi. 2004-5-7
Minim Invasive Surg. 2018-5-14
Int Surg. 2015-2
World J Gastroenterol. 2004-11-1