摘要
目的:探讨腹腔镜胆总管探查术的优点、手术方法、适应证及Ⅰ期缝合的条件。方法:回顾分析2010年12月至2013年6月为48例胆总管结石患者行腹腔镜胆总管探查术的临床资料,总结手术经验,探讨进一步改良方法。结果:45例顺利完成腹腔镜胆总管探查术,3例因腹腔内形成复杂粘连或/和合并门脉高压症而中转开腹。28例行胆总管Ⅰ期缝合,其余患者放置T管引流。2例因结石嵌顿于胆管下端且胆管较细,术后行内镜十二指肠乳头括约肌切开术取石成功,余患者均于术中取尽结石。手术时间平均(102.0±19.8)min,术中出血量平均(41.0±6.5)ml,平均住院(8.2±2.7)d。术后发生轻微胆漏5例,均于术后7 d内自行停止;余者术后均无严重并发症发生。结论:腹腔镜胆总管探查术具有患者创伤小、康复快等优点,在严格掌握适应证的情况下,可行Ⅰ期缝合,是临床治疗胆总管结石值得推广的术式。
Objective： To discuss the advantages,methods,indication of laparoscopic common bile duct exploration and the prerequisite of primary suture. Methods： The operative methods and clinical characteristics of 48 cases with common bile duct calculus treated by laparoscopic common bile duct exploration from Dec. 2010 to Jun. 2013 were analyzed,the operation experiences were summarized in order to explore a modified method. Results： Forty-five cases were successfully accomplished. 3 cases were converted to open operation because of complex intraperitoneal and / or portal hypertension. 28 cases were performed with primary closure of common bile duct,others underwent T tube drainage. 2 cases with calculus incarcerated in lower bile duct and fine bile duct,successfully underwent endoscopic sphincterotomy after operation,the calculi of other patients were completely removed in the surgery. The mean operating time,blood loss and postoperative hospital stay were（ 102. 0 ± 19. 8） min,（ 41. 0 ± 6. 5） ml and（ 8. 2 ± 2. 7） d respectively. Bile leakage occurred in 5 cases and were cured within 7 d,and there were no severe complications occurred in other patients. Conclusions： Laparoscopic common bile duct exploration has the advantages of few invasion and rapid recovery. Primary suture is feasible under the condition of strict indication,it would be an alternative method to be generalized in the treatment of choledocholithiasis.
出处
《腹腔镜外科杂志》
2014年第12期917-919,共3页
Journal of Laparoscopic Surgery
关键词
胆总管结石
胆总管探查术
腹腔镜检查
Ⅰ期缝合
胆道镜检查
Choledocholithiasis
Common bile duct exploration
Laparoscopy
Primary suture
Choledochoscopy
