胆总管切开一期缝合106例临床分析.docVIP

胆总管切开一期缝合106例临床分析 　【摘要】目的评价胆总管切开一期缝合在胆总管切开探查术中的合理应用价值。方法 回顾性分析胆总管一期缝合在胆总管探查术106例病例的临床资料。结果全组病例无一例发生胆漏、胆道感染等并发症。术后平均住院时间9天，随防106例，时间1-5年，平均3年，B超检查无胆管狭窄。结论胆总管一期缝合在胆总管切开探查术中合理应用，对防术后胆道逆行感染、拔管后胆漏、胆汁性腹膜炎和胆汁外流造成的电质平衡紊乱等并发症有显著效果。此法安全、可靠、有效，但要严格掌握适应症。 【关键词】胆总管切开探查;一期缝合; 胆总管结石 【Abstract】objective evaluation of common bile duct exploration and primary suture in common bile duct exploration in the rational application of value. Methods a retrospective analysis of primary suture of common bile duct in the common bile duct exploration in 106 cases of clinical data. Results all of the cases no one case of bile leaks, biliary tract infection and other complications. The average postoperative hospital stay was 9 days, with 106 patients, the time 1-5 year, an average of 3 years, B ultrasound examination no stenosis of bile duct. Conclusion primary suture of common bile duct in the common bile duct exploration in reasonable application, on the prevention of postoperative biliary retrograde infection, extubation after bile leaks, biliary peritonitis and bile drain caused by electric balance disorders and other complications have a significant effect. This method is safe, reliable, effective, but to strictly grasp the indications. 【Key words】 common bile duct exploration and primary suture of common bile duct stones 胆总管切开一期缝合是指胆总管切开探查术后直接缝合胆总管，不放置T管引流的缝合方法。我院1995—2006年共进行胆总管探查手术625例，其中胆总管切开一期缝合106例，疗效满意报告如下。 1临床资料 1.1一般资料.全组106例,男39例(占,女67例,年龄14-71岁,平均41.5岁,单纯性胆总管结石18例(其中6例并发急性梗阻性化脓性胆管炎),胆囊炎合并胆囊结石12例,胆总管结石伴胆囊结石67例,胆总管蛔虫8例,胆总管探查阴性1例。 1.2诊断方法.49例患者术前有明显黄胆史,全部患者均经B超、CT或者ERCP检查排除肝内胆管结石,急性胰腺炎,胆总管及十二指肠肿瘤。 1.3手术方法.在连续硬膜外阻滞下施术,常规腹部切口,合并胆囊结石首先切除胆囊,病变部位纵行切开胆总管长约1.5-2.0CM,取净结石或者蛔虫,冲洗胆管后行胆道镜或胆道造影,确认胆总管下端通畅无胆道残留结石和狭窄,4-0Ppolene线间断全层缝合胆总管,针距在0.2CM不漏胆汁为宜,再间断缝合肝十二指肠韧带桨膜,常规肝下放置引流管一根引出体外。 1.4结果.全组无一例发生胆漏及其它并发症,平均术后住院9天,其中42例随诊3个月至5年,B超检查无结石复发及胆管狭窄,疗效满意。 2讨论 胆总管切开探查T形管引流,可以有效引流胆汁降低胆压,防止感染,胆瘘或胆管狭窄的发生,应用百余年,作为治疗胆总管结石的经典术式,证明是安全有效的,但T管放置过久又能诱发结石.感染,肠瘘,电解质紊乱,甚至在拔管时致胆汁性腹膜炎等并发症.有报道T管技