腹腔镜胆总管探查一期缝合临床应用.docVIP

腹腔镜胆总管探查一期缝合临床应用[摘要] 目的：探讨腹腔镜胆总管探查一期缝合的可行性、手术方法及技巧。方法：对我院2002年2月～2008年10月实施的48例腹腔镜胆总管探查并一期缝合的患者资料进行回顾性分析，并分析治疗效果。结果：平均手术时间（85±20） min，术中平均出血（30±15） ml；并发症3例，其中，胆漏2例，腹腔内出血1例；平均住院时间（6.3±4.0） d，随访4个月～6年，未见胆道残余结石及胆管狭窄。结论：腹腔镜下胆总管探查一期缝合疗效确切，具有住院时间短、痛苦少、恢复快的优点，是一种安全有效的方法，值得推广。 [关键词] 腹腔镜；胆总管结石；一期缝合 [中图分类号] R65 [文献标识码]C[文章编号]1673-7210（2009）05（b）-167-02 The clinical application of the primary suture of common bile duct after laparoscopic common bile duct exploration YANG Nan, LAN Qiang, Zhang Xiaozhou (Department of Liver and Gall Surgery, the First People’s Hospital of Zigong, Zigong643000, China) [Abstract] Objective: To explore feasibility and to investigate the way and skill of common bile duct exploration under laparoscopy with primary suture. Methods: Retrospectively, the therapeutic efficacy of 48 patients with the indications of exploration of common bile duct were analyzed and all the cases were subjected to primary suture after laparoscopic common bile duct exploration. Results: All 48 cases were cured. Average operating time was (85±20) min and average blood loss was (30±15) ml. Complications included intraperitoneal bleeding (1 cases), bile leakage (2 cases). Mean operative hospital stay was (6.3±4.0) days. The patients were followed up for 4 months - 6 years and no biliary duct stricture or the remained bile stones in bile duct. Conclusion: If the indication is properly mastered, the primary suture exploration of common bile duct can be safe and feasible after laparoscopic common bile duct exploration. [Key words] Laparoscopy；Choledocholith；Primary suture 我院2002年2月～2008年10月实施腹腔镜胆总管探查一期缝合(laparoscopic common bile duct exploration and primary suture)48例，术后疼痛轻、进食早、恢复快、住院时间短、医疗费用低、效果满意。现报道如下： 1 资料与方法 1.1 一般资料 本组男26例，女22例；年龄26～70岁，平均40.5岁；病程5个月～7年。术前经B超和（或）ERCP证实为胆囊结石合并胆总管结石42例，6例胆总管结石。临床上都有腹痛、腹胀及消化道症状，黄疸28例。既往有上腹部手术史3例。急诊手术2例。合并糖尿病8例，高血压10例，冠心病2例。 1.2 手术操作 ①切除胆囊：穿刺孔基本同腹腔镜胆囊切除术，于脐上缘、剑突下4 cm、右锁骨中线肋下2 cm、右腋前线肋下3 cm各作长度分别为1.0、1.0、0.