Drouard F, Passone-Szerzyna N, Berthou J C
Centre Hospitalier de Saint Quentin.
Ann Chir. 1995;49(7):596-601.
Laparoscopic exploration of the common bile duct is now technically possible. This prospective study evaluates the feasibility of the different techniques and their complications. From January 1990 to March 1995, 140 patients, aged from 22 to 92, underwent laparoscopic treatment for choledocholithiasis. A transcystic approach was attempted in 70 patients and was successful in 46 (65.7%). The failures were treated by 19 laparoscopic choledochotomies and 5 postoperative endoscopic sphincterotomies. A choledochotomy was performed in 89 cases and was successful in 85 (94.4%). The failures were treated by 3 laparotomies and 2 postoperative endoscopic sphincterotomy. The total success rate was 92.8% (130/140). The 5 local complications were pain (1), liver injury (1), and wound abscess (2), bleeding from a trocar site. Heart failure (medical treatment) (2), gastrointestinal haemorrhage from intestinal angiomas, severe pancreatitis after transcystic failure and psychiatric disorders were the 5 general complications. The total morbidity rate was 7.1%. There were 2 residual common bile duct stones. The mortality rate was 0. Mean hospital stay was 7.8 days. Laparoscopic exploration of the common bile duct appears to be safe and effective and should be included in the management protocol of choledocholithiasis.
目前，腹腔镜胆总管探查术在技术上是可行的。这项前瞻性研究评估了不同技术的可行性及其并发症。1990年1月至1995年3月，140例年龄在22岁至92岁之间的患者接受了腹腔镜治疗胆总管结石。70例患者尝试经胆囊途径，46例（65.7%）成功。失败的患者接受了19例腹腔镜胆总管切开术和5例术后内镜括约肌切开术。89例患者进行了胆总管切开术，85例（9�.4%）成功。失败的患者接受了3例开腹手术和2例术后内镜括约肌切开术。总成功率为92.8%（130/140）。局部并发症有疼痛（1例）、肝损伤（1例）、伤口脓肿（2例）、套管针部位出血。心力衰竭（药物治疗）（2例）、肠道血管瘤引起的胃肠道出血、经胆囊途径失败后的严重胰腺炎和精神障碍为5例全身并发症。总发病率为7.1%。有2例胆总管残余结石。死亡率为0。平均住院天数为7.8天。腹腔镜胆总管探查术似乎安全有效，应纳入胆总管结石的治疗方案。
