Ferguson C M
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
Arch Surg. 1998 Apr;133(4):448-51. doi: 10.1001/archsurg.133.4.448.
To evaluate the effectiveness of laparoscopic common bile duct exploration in unselected patients.
Consecutive sample.
Tertiary care general hospital.
Three hundred and two patients with symptomatic cholelithiasis presenting to a single surgeon during a 5-year period.
Laparoscopic cholecystectomy, cholangiography, and common bile duct exploration.
Successful laparoscopic cholecystectomy and common bile duct exploration.
Three hundred and two consecutive patients underwent cholecystectomy for symptomatic cholelithiasis; 280 of the procedures were successfully completed laparoscopically. Cholangiography was attempted in 269 patients, was successful in 239, and revealed evidence of choledocholithiasis in 25. Preoperative ultrasonography and liver function tests predicted the presence of common bile duct stones in 24% and 32% of patients, respectively. Seven of the patients with choledocholithiasis presented with biliary colic, 7 with biliary colic and jaundice, 8 with acute cholecystitis (3 with gallbladder perforation), 1 with acute cholecystitis and jaundice, and 2 with gallstone pancreatitis. Four of 5 patients underwent successful transcystic exploration with a biliary Fogarty catheter, 12 of 16 patients underwent successful transcystic choledochoscopy and stone basket extraction, and all 4 attempts at choledochotomy and choledochoscopic stone basket extraction were successful, for a total success rate of 80% with laparoscopic common bile duct exploration. One of the failures was converted to an open procedure, and 4 of the failures had successful postoperative endoscopic retrograde cholangiopancreatography and extraction of stones.
Laparoscopic cholecystectomy and common bile duct exploration is a highly successful procedure for the management of common duct stones in an unselected group of patients. Choledochotomy with choledochoscopy is the preferred method of common bile duct exploration.
评估在未经过挑选的患者中进行腹腔镜胆总管探查术的有效性。
连续样本。
三级综合医院。
在5年期间向一位外科医生就诊的302例有症状胆结石患者。
腹腔镜胆囊切除术、胆管造影术和胆总管探查术。
成功的腹腔镜胆囊切除术和胆总管探查术。
302例连续患者因有症状胆结石接受了胆囊切除术；其中280例手术通过腹腔镜成功完成。269例患者尝试了胆管造影术，239例成功，其中25例显示有胆总管结石迹象。术前超声检查和肝功能检查分别在24%和32%的患者中预测出胆总管结石的存在。25例胆总管结石患者中，7例表现为胆绞痛，7例表现为胆绞痛伴黄疸，8例表现为急性胆囊炎（3例伴有胆囊穿孔），1例表现为急性胆囊炎伴黄疸，2例表现为胆石性胰腺炎。5例患者中有4例通过胆道Fogarty导管经胆囊管成功探查，16例患者中有12例通过经胆囊管胆总管镜检查和结石篮取出术成功，4例胆总管切开术和胆总管镜结石篮取出术的尝试均成功，腹腔镜胆总管探查术的总成功率为80%。其中1例失败病例转为开放手术，4例失败病例术后经内镜逆行胰胆管造影术成功并取出结石。
腹腔镜胆囊切除术和胆总管探查术对于未经过挑选的胆总管结石患者群体的治疗是一种非常成功的手术。胆总管切开术联合胆总管镜检查是胆总管探查的首选方法。
