Kelley W E, Sheridan V C
Surg Endosc. 1995 Mar;9(3):293-6. doi: 10.1007/BF00187771.
Incidental choledocholithiasis has been reported in 4-5% of cases during routine cholangiography. Many surgeons have resisted laparoscopic common bile duct exploration as a time-consuming and technically frustrating procedure, preferring to send the patient for postoperative ERCP. The purpose of this study was to objectively assess the safety, efficacy, and facility of transcystic duct choledochoscopy using a small-caliber choledochoscope with facilitated insertion technique. Twenty-five consecutive patients scheduled for laparoscopic cholecystectomy (LC) were studied prospectively. Choledochoscopy was carried out with a simplified introducer system using a 6.9-French choledochoscope. An arbitrary limit of 10 min was established for gaining access to the common bile duct (CBD). Incidental CBD stones were found in two of the 25 procedures (8%) and were cleared laparoscopically. The CBD was successfully entered in 21 of 25 attempts (84%). The average time for the entire procedure was 8.7 min. There were no procedure-related complications. Clinical application of this procedure was reviewed in a personal series of 742 LCs. Transcystic laparoscopic common bile duct exploration (LCDE) was successful in clearing stones from the CBD 75% of the time and the addition of laparoscopic choledochotomy brought the success of LCDE to 81%. Excluding patients where transcystic LCDE was not attempted, the overall success rate was 91%.
据报道，在常规胆管造影检查中，偶然发现胆总管结石的病例占4%-5%。许多外科医生抵制腹腔镜胆总管探查术，认为该手术耗时且技术难度大，更倾向于让患者接受术后内镜逆行胰胆管造影（ERCP）。本研究的目的是使用插入技术简便的小口径胆管镜，客观评估经胆囊管胆管镜检查的安全性、有效性和便利性。对连续25例计划接受腹腔镜胆囊切除术（LC）的患者进行了前瞻性研究。使用简化的导入系统，通过6.9法式胆管镜进行胆管镜检查。规定进入胆总管（CBD）的时间限制为10分钟。在25例手术中有2例（8%）偶然发现CBD结石，并通过腹腔镜清除。25次尝试中有21次（84%）成功进入CBD。整个手术的平均时间为8.7分钟。没有与手术相关的并发症。对个人系列742例LC手术的该手术临床应用进行了回顾。经胆囊管腹腔镜胆总管探查术（LCDE）成功清除CBD结石的时间占75%，加上腹腔镜胆总管切开术使LCDE的成功率提高到81%。排除未尝试经胆囊管LCDE的患者，总体成功率为91%。
