内镜下取石失败后行腹腔镜胆总管探查术。
Laparoscopic common bile duct exploration after failed endoscopic stone extraction.
作者信息
Karaliotas Constantine, Sgourakis George, Goumas Constantine, Papaioannou Nickolaos, Lilis Constantine, Leandros Emmanouel
机构信息
2nd Surgical Department of Korgialenion - Benakion, Red Cross Hospital, 11 Mantzarou str., Neo Psychiko, 15451, Athens, Greece.
出版信息
Surg Endosc. 2008 Aug;22(8):1826-31. doi: 10.1007/s00464-007-9708-8. Epub 2007 Dec 11.
BACKGROUND
Our objective was to present the technical aspects and results of laparoscopic common bile duct (CBD) exploration following failed endoscopic stone extraction.
METHOD
From April 1997 to December 2006, 32 patients were referred to us after unsuccessful attempts at endoscopic CBD stone extraction. Transcholedochal laparoscopic CBD exploration was used in all patients. Previous operations, several pathologic entities, and stone impaction were studied as potential predictors of failure of the laparoscopic approach.
RESULTS
Previous operations, cholangitis, anatomic abnormalities, and stone impaction were the principal reasons for failure of endoscopic retrograde cholangiopancreatography (ERCP). Stone extraction under direct laparoscopic choledochotomy was achieved in 20 of 31 patients (64.51%). Biliary stents were inserted in 7 patients (21.8%) and T tubes were placed in 21 patients (65.6%). Five laparoscopic choledochoduodenostomies were performed. There were 11 conversions to open surgery. Morbidity was 12.5%.
CONCLUSIONS
Laparoscopic choledochotomy is an efficacious procedure in dealing with unsuccessful endoscopic CBD clearance.
背景
我们的目的是介绍内镜下取石失败后腹腔镜胆总管探查术的技术要点及结果。
方法
1997年4月至2006年12月，32例患者在内镜下胆总管取石失败后转诊至我院。所有患者均采用经胆总管腹腔镜胆总管探查术。研究既往手术史、多种病理情况及结石嵌顿作为腹腔镜手术失败的潜在预测因素。
结果
既往手术史、胆管炎、解剖异常及结石嵌顿是内镜逆行胰胆管造影（ERCP）失败的主要原因。31例患者中有20例（64.51%）在直接腹腔镜胆总管切开术后成功取石。7例患者（21.8%）置入了胆道支架，21例患者（65.6%）放置了T管。进行了5例腹腔镜胆总管十二指肠吻合术。有11例转为开腹手术。发病率为12.5%。
结论
腹腔镜胆总管切开术是处理内镜下胆总管清理失败的有效方法。
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