单孔腹腔镜胆囊切除结合腹腔镜下经胆囊管胆总管探查术病例汇报
Journal: Frontier Forum of Clinical Medicine DOI: 10.12238/ffcr.v3i6.17307
Abstract
目的：探讨单孔腹腔镜联合超细胆道镜经胆囊管途径同期治疗胆囊结石合并胆总管结石的技术可行性及临床价值。方法：针对1例53岁女性患者（术前CT确诊胆囊多发结石，合并胆总管结石可能），于脐部建立2.0cm单孔操作通道，胆囊三角解剖清晰，在距胆囊管-胆总管汇合部1cm处切开胆囊管， EyeMax超细胆道镜（外径8.4Fr）经此开口插入胆总管，直视下使用网篮取尽胆总管结石，术中反复检查肝外胆管及肝内一、二级胆管，确认无结石残留后切除胆囊。结果：手术时间140分钟，出血量<20ml，结石清除率100%。患者术后6小时下床活动，3天出院，无胆漏、胰腺炎等并发症。术后随访显示无明显并发症，脐部切口呈线性瘢痕（长2.0cm）。经检索国内外各三大数据库（CNKI/万方/CSCD，Pubmed/Web of Science/Medline，2000-2024年），未见同类技术报道，本例系全国首例单孔腹腔镜下一体化解决胆囊结石及胆总管结石病例。结论：单孔腹腔镜胆囊切除结合经胆囊管胆总管探查术既具微创性，又保留了Oddi括约肌完整，规避了传统T管引流或ERCP二次手术的风险，为胆囊结石合并胆总管结石患者提供了安全有效的治疗新策略，尤其适用于胆囊管直径≥3mm、结石≤1cm的择期手术患者。
Keywords
单孔腹腔镜胆囊切除术；腹腔镜下经胆囊管胆总管探查术；胆总管结石症；微创外科；Oddi括约肌保全
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