腹腔鏡下総胆管切開切石術（Tチューブ留置法）

Laparoscopic Choledochotomy, Stone Removal, and T Tube Placement

　腹腔鏡下総胆管切石，Tチューブ留置術は，術中不完全切石が疑われる症例や，内視鏡的除石が行い得ない症例に適応となる．正確な総胆管切開のためにはstay sutureが有用であり，また愛護的切石に努める．Tチューブは，挿入可能な最大径のものを用い，胆管切開部閉鎖は吸収性縫合材料を用いタイトに行う．

Laparoscopic choledochotomy, stone removal, and T tube placement is indicated when postoperative choledocoscopy via the T tube tract is needed, including when retaining CBD stones are strongly suspected, or when endoscopic stone removal through the duodenal papilla is not technically feasible. For accurate choledochotomy, it is of great help to place stay sutures on the both side of the incision. When retrieving stones, gentle maneuver is mandatory to avoid CBD injury. The largest T tube that can be inserted through choledochotomy should be selected, and choledochotomy should be closed with absorbable suture material.