腹腔镜胆总管探查一期缝合的临床研究

【】　目的　探讨腹腔镜胆总管探查一期缝合的可行性和适应证及临床价值。　方法　回顾性分析2007年7月―2010年10月72例胆管结石患者的临床资料，采用三孔法腹腔镜胆总管探查术，术中胆道镜配合胆道手术器械取石，一期缝合胆总管进行治疗。　结果　72例手术均获成功，无中转开腹，4例出现术后胆漏，经腹腔引流3~5d治愈，无严重并发症。术后住院4~7d（平均4.4d）。72例均获随访，随访时间1~24个月（平均10个月）。术后1个月B型超声，未发现胆道狭窄及残余结石。　结论　腹腔镜胆总管探查术后一期缝合胆总管，安全、有效、微创效果显著，是临床微创治疗胆囊结石合并胆管结石的一种理想术式，值得临床推广应用。其关键是术中取尽结石和把握适应证，同时需要术者熟练掌握胆道镜技术及腹腔镜下胆总管切开缝合、打结等技术。【Abstract】　Objective　Todiscussthefeasibility,indicationsandclinicalvalueoflaparoscopiccommonbileductexplorationwithprimarysuture.　Methods　Weanalyzedtheclinicaldataof72patientswithbiliaryductstonetreatedfromJuly2007toOctober2010.Three-portlaparoscopiccommonbileductexplorationwithprimarysuturewasadopted;choledochoscopyandopenbileductoperationinstrumentswereusedtotakeoutthestonesduringtheoperation;andthecommonbileductwastreatedwithprimarysutureafteroperation.　Results　Alloperationswerecarriedoutsuccessfullywithoutanycaseofconversiontoopenoperation.Bileleakageoccurredinfourcasesandwascuredwithabdominaldrainagetubeforthreetofivedayswithoutanyseverecomplications.Postoperativehospitalizationtimerangedfromfourtosevendays,averagingat4.4days.Allpatientswerefollowedupforoneto24months(averagingat10months).B-modeultrasonographyexaminationonemonthafteroperationshowednobiliarytractstrictureorresidualstone.　Conclusions　Laparoscopiccommonbileductexplorationwithprimarysutureissafe,reliable,minimallyinvasive,moreeffective,andcanberegardedasanidealoperativemethodforthetreatmentofcholecystolithiasiscombinedwithbiliaryductstoneinclinicalpractices.Itisworthpopularizing.Thekeyelementsforasuccessfuloperationlieincompletelytakingoutthestonesandhavingasoundknowledgeofindications.Furthermore,surgeonsshouldmastertheskillsincholedochoscopytechniques,laparoscopicincision,sutureandligation.