自制伞形胆道内引流管在腹腔镜胆总管切开取石中的临床应用.DOCVIP

临床医学论文-自制伞形胆道内引流管在腹腔镜胆总管切开取石中的临床应用 ????? 作者：彭毅　周汉新　叶建宇　周晓初　钟立明　张风涛　尹耀新　熊沛 ? 【摘要】? 目的? 改变电视腹腔镜胆总管切开取石术后需留置“T”管的状况，并弥补胆总管一期缝合后胆漏等现象的不足。方法? 采用自制直径3～5mm伞式J形防回缩引流管，留置于胆总管内，并在电视屏幕监视下应用单人双手操作法，缝合胆总管壁层、浆膜层。结果? 术者均能在腹腔镜下完成各种操作，成功地在胆总管内留置内引流管共79例，无一例体内滞留内引流管，病人术后恢复快，住院时间短。结论? 该手术方式适用于腹腔镜下胆囊结石并胆总管结石或胆总管巨大结石，尤其适宜于需保留Oddi括约肌功能的青少年患者，其疗效和恢复劳力过程明显优于腹腔镜胆总管切开取石后留置有“T”管的术式。 　　【关键词】? 微创外科；腹腔镜；胆道镜；胆囊结石；胆总管结石；胆总管探查；胆道引流T管??? 　　Laparoscopic choledocholithotomy with primary suture and drainage with biliary endoprostheses 　　【Abstract】? Objective? To assess the safety, feasibleness and effectiveness of laparoscopic one-stage management of calculous cholecystitis associated with common bile duct stones (CBDS).To avoid T-tube drainage in laparoscopic choledocholithotomy.Methods? From April 1999 to may 2005,79 patients (33 male,46 female, median age 47 years, range 24～85) with calculous cholecystitis complicated by CBDS underwent laparoscopic cholecystectomy (LC) and laparoscopic common bile duct (CBD) explortion with stones transcholedochal extraction. 77 cases had drainage with biliary endoprostheses (Φ3～5mm self-made hook plastic stent) and primary closure of CBD.Results? Laparoscopic choledocholithotomy was successful in 77 patients. Mean operating time was 126 minutes. None had retained stones. Post-operative hospital stay averaged 8 days (range 2.5～13). The biliary endoprostheses was self-removed in 3～40 days.Conclusion? Laparoscopic Choledocholithotomy with primary suture and drainage with biliary endoprostheses is viable and minimally invasive treatment option for CBDS. Especially in cases where a cholecystectomy is needed or Oddis sphincter need remaining for young patients, laparoscopic surgery should be considered as first line treatment in medically fit patients.It is preferable to T-tube drainage. 　　【Key words】? minimally invasive surgery; laparoscopy; duodenoscopy; choledocholthiasis; common bile duct exploration; bile duct drainage ??? 胆总管切开探查或取石后需留置T管是胆总管手术的经典方法，为了改变这一施行了百余年术