胆总管探查后一期缝合的经验和认识.PDFVIP

·论著· 胆总管探查后一期缝合的经验和认识 许龙堂郑樟栋张家敏毛根军吴荣进 厉学民吴晓康俞世安沈蔚曾天定 【摘要】 目的探讨胆总管探查后一期缝合的经验和认识。方法对1990年1月至2004年6 月因肝外胆管结石择期行胆总管探查后一期缝合的271例作一回顾性分析。所有病例不含肝内胆管 结石，术中经胆道镜或胆道造影排除胆道残石并常规放置右肝下引流管。结果术后14例腹腔引流 液含胆汁，均未特殊处理。术后平均住院8．73d。所有病例术后3个月内门诊B超复查，未发现胆道 残石。216例(79．70％)获得远期随访，无一例发现肝外胆管狭窄。结论对经过严格选择的肝外胆 管结石病例，胆总管探查后不应强调一律放置T管。术中精细操作和经术中胆道镜或胆道造影检查 排除残石后，一期缝合可作为术式选择。 【关键词】胆总管结石；胆总管；胆石症；胆道疾病 ductd惦ure D畔畦蛐傥inpr呻con蚰∞bileaft盯choled∞h0协myXULo咒g觑咒g，ZHENG互飘n咒g一 C锄￡mZ 如竹g，ZHANGJi口m切，甜nZ．Ji竹^眦M沥捌抛ZHos声i缸Z，Ji矶讹321000，P．R．吼i触 Tosummarizethe in closureofconⅢ10nbileductfol— 【Abs的ct】objective experienceprirllary to forcommonbileductcalculi．MethodsFlom 1990 2004，271 lowingcholedochotomy January June with of inthe bileductreceived closureoftheconlmon patientstheevidencestones cormon primary bileductafter underwent wereeXcluded-Intra— choledochotomy．Thosepatients emergencyoperations or were toruleoutthe of operativech01edochoscopycholangiographyroutinelyperfomed possibility retainedstones．Theductwas stitched to absorbentsuturesfor meticulouslyusing0／3 O／5 primary closure．Asuction inthe forallthe drainagestrip、vasplaced subhepaticspace patients．R鹤ulb in14 andno was The tinle fostoperativebileleakagewasseen patientsreoperationnecessarnaverage of 8．73d． Ultrasoundre—ex删nation、vasfor postoperativehospitalstayⅥ阻s perfomledeverypatient in3monthsafter andnoco姗onbileductretainedstones、代refound．The fol一 operation long_tem in216