胆总管探查术后一期缝合32例临床分析.DOCVIP

临床医学论文-胆总管探查术后一期缝合32例临床分析 【关键词】? 胆总管切开探查术 　　［摘? 要］ 目的：探讨胆总管切开探查胆管一期缝合的方法和效果。方法：对32例患者行胆道探查，取尽结石或蛔虫，检查胆总管下段通畅，经胆囊管胆道造影后一期缝合胆管。结果：26例胆总管结石，1例胆道蛔虫，5例探查结果阴性。全部一期缝合，术中胆道造影肝内外胆管无异常。术后4例少量漏胆，进行保守治疗，全组术后9 d~12 d治愈出院。结论：肝外胆管结石、蛔虫已取尽，术中胆道造影证实肝内外胆管无异常，胆总管切开探查后胆管一期缝合安全、有效。 　　［关键词］ 胆总管切开探查术；一期胆总管缝合术；临床分析 　　Clinical Evaluation of Bileduct Exploration with Onestage Suture for 32 Patients 　　ZHANG Ruitao，WANG Shuangquan 　　(General surgery,XD Groups Hospital Xian,Shannxi 710077,China) 　　Abstract：Objective To evaluate clinical effection of bileduct exploration with onestage suture.Methods In choledochotomy of 32 cases,make sure it is unabstructed after cleaning all the stones and ascaricls,then it is sewed up primarily and conformed by cholangiongraphy.Results 32 cases were primarily sewed up after all the stone and ascarids were cleaned,conformed by cholangiongraphy that there is nothing abnormal in operation.4 case which leaked bile after operation received conservative therapy and all cases were healed 9 days~12 days later.Conclusion To select operative indication strictle and operating precisely,common bileduct exploration with primary sture would be safe and feasible. 　　Key words：Bileduct exploration；onestage suture； Clinical analysis ??? 胆道探查术置T形管引流自Kehr 1889年创用以来，一直作为经典术式常规应用。特别对胆道感染、残余结石的处理具有确切疗效。但放置T管也给患者带来一些不便，且住院时间延长，住院经费增加，甚至出现一些严重的并发症：如T形管意外脱落、拔管后窦道愈合不良出现胆漏、胆汁性腹膜炎、胆道感染、胆道狭窄等。因此，不少学者对胆总管切开探查后胆管一期缝合术可行性不断进行了研究探讨，并取得了一定临床经验。近四年来，我们采用胆总管探查胆管一期缝合，同时经胆囊管插管胆道造影的方法治疗胆总管结石、胆道蛔虫症32例，临床效果满意。现报告如下。 　　1? 临床资料 　　1．1? 一般资料? 　　本组32例，男13例，女19例，年龄22岁~78岁，平均40岁。单纯胆总管结石4例，胆总管结石伴胆囊结石23例，胆道蛔虫症1例，胆道扩张经探查阴性者4例。急诊手术5例，择期手术27例，术前排除肝内胆管结石、急性胰腺炎、胆总管及十二指肠肿瘤。 　　1．2? 手术方法? 　　先确认有胆道探查术指征。常规切除胆囊。留置胆囊管2 cm~3 cm备术中插管造影。于十二指肠上缘1 cm切开胆总管前壁1 cm~2 cm，取净结石、蛔虫。检查左右肝管、胆总管下段通畅无狭窄。反复冲洗肝内外胆管，经胆囊管插入输液器头皮针细塑料管于胆总管内，丝线固定胆囊管导管。以40prolene线全层连续缝合胆总管切口(针距0.2 cm)，再间断缝合肝十二指肠韧带腹膜层。经胆囊管导管注水，检查胆管缝合部位有无渗漏。再经导管注入30%泛影葡胺行术中胆道造影，证实肝内外胆管无异常。拔除导管，结扎胆囊管。于肝下Winslow孔处放置双套管引流。 　　2? 结果 　　本组4例术后腹腔引流管引出胆汁样液体，最多40 ml/d，最少10 ml/d。保持引流通畅，引流物