Single-port laparoscopic combined with transoral cholangioscopy for the treatment of gallbladder and common bile duct stones: Case report
单孔腹腔镜联合经口胆道子镜治疗胆囊及胆总管结石：病例报告

摘要

目的 探讨单孔腹腔镜联合经口胆道子镜（POCS）技术，一期治疗胆囊结石合并胆总管结石的技术可行性、安全性及临床价值。方法 对1例31岁女性患者（术前MRCP确诊胆囊及胆总管下段多发结石，伴急性胆囊炎、胆管炎及肝功能损害）行单孔腹腔镜手术。于脐部作20mm单孔切口，建立操作通道。解剖胆囊三角，切开胆囊管侧壁，置入导丝经胆总管进入十二指肠。随后，经口引入十二指肠镜及胆道子镜，循导丝进入胆总管，行网篮取石，确认无结石残留后切除胆囊。结果 手术顺利完成，术中基本无出血，结石清除率100%。术后患者恢复良好，无胆漏、胰腺炎等并发症。病理报告为慢性结石性胆囊炎。结论 单孔腹腔镜联合经口胆道子镜技术，可在一次麻醉、单一脐部切口下，同时处理胆囊及胆总管结石，避免切开胆总管、留置T管或损伤Oddi括约肌，体现了微创与功能保留的精准外科理念，具有良好的临床应用前景。

Abstract

Objective To evaluate the technical feasibility, safety, and clinical value of single-incision laparoscopy combined with peroral cholangioscopy (POCS) for the one-stage management of gallstones and common bile duct (CBD) stones.
Methods A 31-year-old female patient with preoperatively confirmed multiple gallbladder and CBD stones (via MRCP), accompanied by acute cholecystitis, cholangitis, and impaired liver function, underwent single-incision laparoscopic surgery. A 20-mm umbilical incision was made to establish the single-port access. After dissection of Calot ' s triangle, the cystic duct was incised laterally, and a guidewire was introduced through the CBD into the duodenum. Under duodenoscopic guidance, a cholangioscope was advanced perorally into the CBD via the guidewire for stone extraction using a basket. Cholecystectomy was performed after confirming complete clearance of stones.
Results The procedure was successfully completed with minimal intraoperative bleeding and a 100% stone clearance rate. The patient recovered well postoperatively without complications such as bile leakage or pancreatitis. Pathological examination confirmed chronic calculous cholecystitis.
Conclusion   The combination of single-incision laparoscopy and peroral cholangioscopy allows simultaneous treatment of gallbladder and CBD stones in a single session, through one umbilical incision, without CBD incision, T-tube drainage, or injury to the sphincter of Oddi. This approach embodies the concept of minimally invasive and function-preserving precision surgery, showing promising clinical applicability.