Chen Dawei, Fei Zhewei, Huang Xia, Wang Xiaojun
Department of General Surgery, ChongMing Branch, Shanghai XinHua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
JSLS. 2014 Jul-Sep;18(3). doi: 10.4293/JSLS.2014.00184.
One-stage laparoscopic management for common bile duct stones in patients with gallbladder stones has gained wide acceptance. We developed a novel technique using a transcystic approach for common bile duct exploration as an alternative to the existing procedures.
From April 2010 to June 2012, 9 consecutive patients diagnosed with cholelithiasis and common bile duct stones were enrolled in this study. The main inclusion criteria included no upper abdominal surgical history and the presence of a stone measuring <5 mm. After the gallbladder was dissected free from the liver connections in a retrograde fashion, the fundus of the gallbladder was extracted via the port incision in the right epigastrium. The choledochoscope was inserted into the gallbladder through the small opening in the fundus of the gallbladder extracorporeally and was advanced toward the common bile duct via the cystic duct under the guidance of both laparoscopic imaging and endoscopic imaging. After stones were retrieved under direct choledochoscopic vision, a drainage tube was placed in the subhepatic space.
Of 9 patients, 7 had successful transcystic common bile duct stone clearance. A narrow cystic duct and the unfavorable anatomy of the junction of the cystic duct and common bile duct resulted in losing access to the common bile duct. No bile leakage, hemobilia, or pancreatitis occurred. Wound infection occurred in 2 patients. Transient epigastric colic pain occurred in 2 patients and was relieved by use of anisodamine. A transient increase in the amylase level was observed in 3 patients. Short-term follow-up did not show any recurrence of common bile duct stones.
Our novel transcystic approach to laparoscopic common bile duct exploration is feasible and efficient.
胆囊结石患者胆总管结石的一期腹腔镜治疗已得到广泛认可。我们开发了一种新颖的技术，采用经胆囊途径进行胆总管探查，作为现有手术方法的替代方案。
2010年4月至2012年6月，本研究纳入了9例连续诊断为胆石症和胆总管结石的患者。主要纳入标准包括无上腹手术史且存在直径<5mm的结石。以逆行方式将胆囊从肝脏连接处游离后，通过上腹部右侧的端口切口取出胆囊底部。在体外将胆道镜通过胆囊底部的小开口插入胆囊，并在腹腔镜成像和内镜成像的引导下经胆囊管向胆总管推进。在胆道镜直视下取出结石后，在肝下间隙放置引流管。
9例患者中，7例成功经胆囊清除胆总管结石。胆囊管狭窄以及胆囊管与胆总管交界处的解剖结构不利导致无法进入胆总管。未发生胆漏、胆道出血或胰腺炎。2例患者发生伤口感染。2例患者出现短暂的上腹部绞痛，使用山莨菪碱后缓解。3例患者观察到淀粉酶水平短暂升高。短期随访未显示胆总管结石复发。
我们新颖的经胆囊腹腔镜胆总管探查方法可行且有效。
