目的 探讨腹腔镜下经胆囊管汇入部切开行胆道探查、取石的可行性及临床价值.方法 通过对17例胆囊结石合并胆总管结石患者采取切开胆囊管汇入部,探查、取石,术后间断缝合胆囊管切口,生物夹夹闭或缝扎胆囊管.术后观察腹腔引流量、肝功能变化及并发症情况.结果 术后腹腔引流量(37±16)ml,无胆瘘发生,肝功能胆红素及酶学无明显升高,术后1周B超检查无腹腔积液,术后5个月随访B超检查无胆总管狭窄.结论 腹腔镜下经胆囊管汇入部切开行胆道探查手术安全、可靠,且对胆囊管结石嵌顿、胆总管较大结石及胆囊管较细的患者同样适用.%Objective To evaluate the route, feasibility and clinic value of biliary tract exploration and stone removal by laparoscopy through the incision access at the confluence part of CBD and cystic duct. Methods The cystic duct of seventeen patients diagnosed as cholecystolithiasis and choledocholith were incised at the confluence part, interrupted sutures were made to the incision, the cystic duct were then occluded, sutured or ligated. The drainage flow, changes of liver function and complication were observed postoperatively. Results The postoperative abdominal drainage was 37 ± 16ml. No cases with bile leakage and bilirubin and liver enzymes increased slightly. B - ultrasound examination performed one week after operation indicated no ascites and no common bile duct stenosis five month later. Conclusion The method is safe, reliable, and also suitable for patients with calculus of cystic duct incarceration and slim cystic duct. It is worthy of clinical application and popularization.
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