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目的 介绍经镜下胆总管内置支架治疗胰腺癌胆管梗阻的手术方法。方法 1999～ 2 0 0 2年采用腹腔镜胆总管探查术 (LCDE)结合斑马导丝、胆管扩张导管、塑料胆管支架和自膨式金属胆管支架施行腹腔镜胆总管支架术 (LCBDS) 12例。结果 12例转移病灶取标本中 9例病理报告胰腺癌 ,3例未证实。 12例中 9例手术获成功 ,1例因狭窄上端波及肝总管而中转开腹放置塑料支架同时T管引流 ,1例少量胆漏腹腔引流 4d后自愈 ,1例放置塑料支架同时T管引流术后 15d死于胆管感染诱发肝肾功能衰竭。结论 选择合适病例 ,采用腹腔镜胆总管支架术处理胰腺癌胆管梗阻是一种有效、安全、简便、可行的术式
Objective To introduce a surgical method for the treatment of biliary obstruction of pancreatic cancer by endoscopic embolization of common bile duct. Methods Twelve cases of laparoscopic common bile duct stenting (LCBDS) underwent laparoscopic common bile duct exploration (LCDE) combined with zebra guidewire, biliary dilatation catheter, plastic biliary stent and self-expanding biliary stent were performed between 1999 and 2002. Results Of the 12 cases of metastatic lesions, 9 cases were pathologically reported for pancreatic cancer and 3 cases were not confirmed. Among the 12 cases, 9 cases were successful in surgery, 1 case was due to stenosis and spread to the common hepatic duct, while the plastic stent was placed in open surgery. At the same time, T-tube drainage was performed. A small amount of bile leakage and peritoneal drainage were cured 4 days later. After 15 days died of bile duct infection induced liver and kidney failure. Conclusion Choosing the right case and using laparoscopic common bile duct stenting to treat bile duct obstruction of pancreatic cancer is an effective, safe, simple and feasible procedure