Petelin J B
Department of Surgery, University of Kansas School of Medicine, Shawnee Mission 66204.
Am J Surg. 1993 Apr;165(4):487-91. doi: 10.1016/s0002-9610(05)80947-x.
The author reviews his experience with the laparoscopic management of common duct pathology and compares it with the experience of others as reported in the literature. Routine intraoperative cholangiography is advocated. A variety of methods of managing common duct stones laparoscopically is presented. These include balloon-catheter manipulation, fluoroscopically guided basket extraction, and choledochoscopic evaluation and removal of stones. The accumulated experience indicates that more than 90% of common duct stones can be removed laparoscopically via the cystic duct. This approach significantly reduces the need for either preoperative or postoperative endoscopic retrograde cholangiopancreatography. Although laparoscopic choledochotomy has been employed in a number of cases and can be performed with a high degree of safety and efficacy, it is needed only infrequently. This form of management results in decreased dependence upon T-tubes, thereby reducing postoperative morbidity and the length of hospitalization. A rational protocol for the management of common duct pathology is presented.
作者回顾了其腹腔镜治疗胆总管病变的经验，并与文献报道的其他作者的经验进行了比较。提倡术中常规行胆管造影。介绍了多种腹腔镜治疗胆总管结石的方法。这些方法包括球囊导管操作、透视引导下网篮取石以及经胆管镜评估和取石。积累的经验表明，超过90%的胆总管结石可通过腹腔镜经胆囊管取出。这种方法显著减少了术前或术后内镜逆行胰胆管造影的需求。尽管腹腔镜胆总管切开术已在一些病例中应用，且能以高度的安全性和有效性进行，但仅偶尔需要。这种治疗方式减少了对T管的依赖，从而降低了术后发病率和住院时间。本文提出了一个合理的胆总管病变治疗方案。
