目的 探讨腹腔镜胆囊切除联合小切口胆总管探查治疗胆囊结石合并胆总管多发结石.方法 本组23例胆囊结石合并胆总管多发结石,均来自2007年12月至2012年7月我院收治患者,采用腹腔镜下切除胆囊并解剖显露胆总管前壁,镜下确定腹壁切口位置,做3 ～5 cm切口入腹,经小切口切开胆总管,取石钳取石后根据情况用纤维胆道镜/硬性输尿管镜行胆道探查取石.结果 本组无1例中转扩大切口手术,手术时间90 ～160 min,平均(120±10) min；住院时间10 ～20 d,平均13 d;21例拔除“T”管痊愈出院；2例术后“T”管造影B超检查右肝管残留结石,带管出院,术后6周经胆道镜取石痊愈；2例肺部感染,伤口均甲级愈合.结论 该术式治疗胆囊结石合并胆总管多发结石创伤小,较单纯小切口安全,比全腹腔镜术式节省时间,取石彻底,适合基层医院.%Objective To investigate the application of laparoscopic cholecystectomy (LC) combined with common bile duct exploration (CBDE) through a small incision in the treatment of gallstone with common bile duct stones.Methods A total of 23 cases of gallstone with common bile duct stones underwent laparoscopic cholecystectomy; the anterior wall of common bile duct was exposed under the laparoscope,and a 3-5 cm incision was made in the abdominal wall accordingly; the common bile duct was cut through the small incision,and stones were removed from the common bile duct with stone forceps; the fiber choledochoscope and rigid ureteroscope were used for common bile duct exploration and further stone removal if needed.Results Incision extension was not needed in any case.The time of operation was 90-160 min (mean,120 ± 10 min) ; the hospital stay was 10-20 d (mean,13 d).Twenty-one cases were cured and discharged after the T-tube was pulled out.Two cases had residual stones in the right hepatic duct after operation,as detected by T-tube cholangiography and B-mode ultrasound,and were discharged with the T -tube in place; the 2 cases had the residual stones removed by the choledochoscope at 6 weeks after operation and were cured.Two cases had pulmonary infection,and both had grade A healing.Conclusion LC combined with CBDE through a small incision is minimally invasive; it is safer than the laparoscope-free procedure through a small incision,and it is more efficient and has better stone removal effect compared with total laparoscopic surgery.This surgical approach is suitable for use in primary hospitals.
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