Deparment of Surgery, IMC Hospital, Mersin, Turkey.
World J Surg. 2010 Aug;34(8):1894-9. doi: 10.1007/s00268-010-0534-0.
The development of laparoscopic cholecystectomy as a minimally invasive approach to eliminate gallstones, in conjunction with increasingly sophisticated techniques for removal of common bile duct (CBD) stones by endoscopic sphincterotomy, has revolutionized the treatment of choledocholithiasis. We describe a new technical approach to laparoscopic exploration of the CBD after unsuccessful endoscopic stone extraction.
Eleven patients were subjected to laparoscopic exploration of the CBD with choledochotomy using a rigid scope (24-Fr nephroscope) during the last 2 years. Of these patients, 10 had unsuccessful preoperative (7 cases) or intraoperative (3 cases) stone extraction, and 1 case had a single impacted stone 2.3 cm in diameter. Five patients had a single bile duct stone and 6 patients had multiple stones. The size of the stones ranged from 9.5 to 24 mm (mean = 12.6 +/- 4 mm).
Balloon dilation of the papilla of Vater was done in all patients. Most of the stones were fractured and pushed into the duodenum with rigid grasping forceps but a lithotripter was required in 2 patients. Stone clearance was 100%; complications related to the procedure were not observed. After CBD clearance, primary closure of the choledochotomy was achieved in 10 patients. In 1 patient who had CBD perforation during a previous procedure, choledochotomy was closed over a T-tube. The mean operative time was 124 +/- 26.7 min (range = 84-165 min) and the mean postoperative hospital stay was 4 +/- 1.7 days (range = 3-7 days).
Laparoscopic exploration of the CBD with a rigid scope is an efficacious procedure in dealing with unsuccessful endoscopic stone extraction.
腹腔镜胆囊切除术作为一种微创方法来消除胆结石，结合内镜下括约肌切开术越来越复杂的技术来取出胆总管（CBD）结石，彻底改变了胆总管结石病的治疗方法。我们描述了一种新的技术方法，用于在不成功的内镜取石后对 CBD 进行腹腔镜探查。
在过去的 2 年中，我们对 11 例患者进行了腹腔镜 CBD 探查，采用刚性镜（24Fr 肾镜）行胆总管切开术。这些患者中，有 10 例术前（7 例）或术中（3 例）取石不成功，1 例直径为 2.3cm 的单发嵌顿结石。5 例患者有单个胆管结石，6 例患者有多个结石。结石大小为 9.5-24mm（平均=12.6+/-4mm）。
所有患者均行 Vater 乳头球囊扩张。大多数结石用刚性抓钳碎裂并推入十二指肠，但有 2 例患者需要碎石器。结石清除率为 100%；未观察到与该程序相关的并发症。在 CBD 清除后，10 例患者行胆总管切开术一期缝合。在 1 例先前手术中 CBD 穿孔的患者中，胆总管切开术在 T 管上关闭。平均手术时间为 124+/-26.7 分钟（范围=84-165 分钟），平均术后住院时间为 4+/-1.7 天（范围=3-7 天）。
采用刚性镜行腹腔镜 CBD 探查是处理内镜取石不成功的有效方法。
