Laparoscopic Common Bile Duct Exploration: Experience of 22 Patients

腹腔鏡總膽管探查術：22位病人的經驗

巫奕儒(Yi-Ju Wu) ； 吳鴻昇(Hurng-Sheng Wu) ； 周德敖(Dev-Aur Chou) ； 唐明政(Min-Zheng Tang) ； 洪敏章(Min-Chang Hung) ； 許志宏(Chin-Hung Hsu) ； 蔡志宏(Chi-Hung Tsai) ； 楊志宗(Jyh-Chung Yang) ； 黃明和(Min-Ho Hung)

《Formosan Journal of Surgery》 38卷6期 (2005/12) Pp. 274-278

https://doi.org/10.29833/FJS.200512.0002

摘要

總膽管結石使用腹腔鏡探查由其他醫學報告已知有好處，本篇目的在於研究有總膽管結石的病人在我們醫院使用腹腔鏡探查總膽管的初步結果。
收集從民國八十九年一月至民國九十一年十二月在本院所有總膽管結石並接受腹腔鏡探查的病人，但若合併有肝內結石者排除在外。腹腔鏡探查總膽管的方法是採用總膽管切開術及T形管引流。
結果在這段期間，有619位病人接受膽囊切除術，而其中有512位(84%)病人接受腹腔鏡膽囊切除術。其中69位(11%)病人有總膽管結石，而36位(52%)病人是經由傳統開放式手術取石。腹腔鏡總膽管探查只使用在22位(32%)臨床上血壓穩定的病人。但有二位轉為傳統開放式取石術。我們將這22位接受腹腔鏡手術的病人分為兩組。前17位病人為A組，後5位病人為B組。無手術死亡病患。二位(9%)病人有手術併發症，一位(4.5%)殘留結石。另一位病人因再發性結石接受肝內空腸吻合術。
總之，腹腔鏡總膽管探查術尚未被接受成標準的總膽管探查術。且需要更好的腹腔鏡縫合技術。我們將來需要更多的病人數目來分析數據以評估他的安全性及可行性。

並列摘要

Laparoscopic common bile duct exploration (LCBDE) is gaining favor for the management of common bile duct stones. This study presents our laparoscopic approach in patients with common bile duct stones.
Materials and Methods: Between January 2000 and December 2002, 69 patients with CBD stones were reviewed and collected information. Thirty-six patients (52%) of these 69 patients with CBD stones were managed by open exploration. LCBDE was attempted in 22 selected patients (32%) with stable hemodynamic states. The other 11 patients (16%) were managed by robot-assisted LCBDE. LCBDE was carried out with a choledochotomy and T-tube drainage.
Results: We divided the 22 patients who had undergone LCBDE into two groups for analysis. In two cases (9%), the LCBDE was converted to open common bile duct exploration. The first 17 patients were assigned to group A, and the last 5 patients to group B. There were no operative mortalities, but 2 cases of complications (9%) in group A, and 1 case of retained stones (4.5%) in group B. One patient with recurrent stones underwent hepaticojejunostomy.
Conclusions: LCBDE is not yet accepted as the standard procedure for choledocholithiasis, and we need more cases to fully evaluate the safety and feasibility of LCBDE for further trials and meta-analyses.

並列關鍵字

common bile duct stone ； laparoscopic common bile duct exploration