探讨在腹腔镜胆总管探查术中采用经腹顺行引导法逐级扩张导管乳头扩张术(LPCD)治疗胆囊结石、胆总管结石、或合并十二指肠乳头部梗阻的应用体会。

回顾性分析1998年10月至2017年5月期间，符合入选标准的253例患者的临床资料。

腹腔镜下成功切除胆囊253例；胆管镜取石、逐级导管扩张乳头并行一期缝合术88.1% (223/253)，因胆总管残石或狭窄留置T形管6.3% (16/253)；中转为术中内镜乳头切开术和鼻胆管引流术3.2% (8/253)；中转为开腹胆总管探查取石T管引流术1.2% (3/253)，放弃胆总管探查取石术1.2% (3/253)。一期缝合术后残石1例(0.4%)，放弃胆总管探查取石3例(1.2%)，胆汁漏17例(6.7%)，轻症胰腺炎5例(2.0%)。无肠穿孔、胆管穿孔、大出血、重症胰腺炎等并发症，无围手术期再手术和死亡。术后总并发症发生率为10.3%(26/253)。

从本研究对有限病例进行初步研究发现，只要病例选择合适，在腹腔镜胆总管探查术中采用LPCD治疗胆囊结石、胆总管结石、或合并十二指肠乳头部梗阻是可行、有效和安全的。

To explore the surgical technique and clinical effect of laparoscopic duodenal papilla step by step dilatable catheter dilatation of transabdominal consequent guidance technology (LPCD) for treatment of extrahepatic bile duct stones or the obstruction of papillary during the course of laparoscopic common bile duct exploration.

The clinical data of 253 patients met the criteria from October 1998 to May 2017 were retrospectively analyzed.

Successful laparoscopic cholecystectomy was proformed in all the 253 cases. Laparoscopic duodenal papilla step by step dilatable catheter dilatation with primary suture was proformed in 223 cases. T-tube was indwelled in 16 cases for common bile duct stricture or residual gallstones. 8 cases were converted to intraoperative ERCP and ENBD. 3 cases were converted into open surgery. Common bile duct exploration was given up in 3 cases. Residual gallstones after primary suture was found in 1 cases. Bile leakage was found in 17 cases.Mild pancreatitis was found in 5 cases. No Intestinal perforation, bile duct complications such as perforation, bleeding, severe pancreatitis, perioperative reoperation, and death cases were found. The total complication rate was 10.3%.

From our preliminary and limited study, we found that if the case permitted, laparoscopic duodenal papilla step by step dilatable catheter dilatation of transabdominal consequent guidance technology is feasible, effective and safe for treatment of extrahepatic bile duct stones or the obstruction of papillary during the course of laparoscopic common bile duct exploration.