肝胆胰外科杂志2025，Vol.37Issue(5)：321-325,5.DOI:10.11952/j.issn.1007-1954.2025.05.006
经胆囊管改良胆总管微切开术在腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石中的临床应用
Clinical application of modified mini-choledochotomy via the cystic duct in laparoscopic combined cholangioscopic treatment for gallbladder stones with common bile duct stones
陈晶晶 1田峥嵘 1王贝尔 1钟熙豪 1王继生 1童洪飞 1王兆洪1
作者信息
- 1. 温州医科大学附属第二医院普通外科,浙江 温州 325000
- 折叠
摘要
Abstract
Objective To explore the clinical application value and safety of modified mini-choledochotomy via the cystic duct in laparoscopic combined cholangioscopic treatment for gallbladder stones with common bile duct stones(CBDS).Methods A retrospective analysis was conducted on 22 patients with gallbladder stones and CBDS treated at the Second Affiliated Hospital of Wenzhou Medical University from Jan.2023 to Dec.2023.Modified mini-choledochotomy via the cystic duct was performed under laparoscopy and cholangioscopy.For stones that could not be extracted solely through the cystic duct,an incision along the longitudinal axis of the cystic duct was extended into the common bile duct(CBD),followed by a mini-incision perpendicular to the CBD longitudinal axis.Stones were removed via a basket through the cystic duct,and the CBD and cystic duct openings were sutured after complete stone clearance.Efficacy and safety outcomes were evaluated.Results All 22 patients achieved successful cholangioscopic CBD access and complete stone removal,with no intraductal pus accumulation or residual intrahepatic stones.No intraoperative complications,such as biliary hemorrhage,duct perforation,or Oddi sphincter injury,occurred.The mean operative time was(72.64±10.02)min,with an intraoperative blood loss of(19.32±9.42)mL.The mean duration of postoperative drainage tube retention was(5.32±0.89)d,and the mean total hospitalization time was(6.36±0.95)d.Postoperative bile leakage occurred in 2 cases(9.09%),resolving spontaneously within 3-4 d,likely due to suture needle hole leakage after edema subsided.No severe complications(e.g.,hemorrhage)was observed.Follow-up was performed for liver function tests,blood tests,and hepatobiliary ultrasound revealed no residual/recurrent stones,biliary strictures,or duct dilation.Conclusion Modified mini-choledochotomy via the cystic duct in laparoscopy combined cholangioscopy,which is safe and effective for treating gallbladder stones with CBDS,and facilitating early postoperative recovery.关键词
腹腔镜手术/胆道镜手术/胆总管微切开/经胆囊管/胆总管结石/一期缝合/改良术式Key words
laparoscopy/cholangioscopy/mini-choledochotomy/trans-cystic approach/common bile duct stones/primary closure/modified technique分类
临床医学引用本文复制引用
陈晶晶,田峥嵘,王贝尔,钟熙豪,王继生,童洪飞,王兆洪..经胆囊管改良胆总管微切开术在腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石中的临床应用[J].肝胆胰外科杂志,2025,37(5):321-325,5.
