胆总管结石切开探查取石后一期缝合治疗胆总管结石临床研究.docVIP

胆总管结石切开探查取石后一期缝合治疗胆总管结石临床研究 　　摘要：目的：探讨胆总管切开探查取石后一期缝合治疗胆总管结石的临床疗效，方法： 对我院自2013年1月-2014年6月75例具有胆道探查指征的患者，实施开腹或腹腔镜下胆总管切开、胆道镜探查取石，探查结束后不放置T管而用4-0或5-0的可吸收缝合线一期缝合。观察住院天数，患者术后引流天数、住院费用等指标。评价胆总管一期缝合治疗胆总管结石的优缺点。结果 ：74例痊愈出院，1例术后发现胆漏经保守治疗后治愈出院，平均手术时间开腹组为103分钟，腹腔镜组为92分钟，平均术后住院时间开腹组8天，腹腔镜组4天，腹腔引流时间两组都是3天。术后随访均超过6个月。B超示无胆绞痛、黄疸发生，无结石残留及复发，无胆总管狭窄。结论： 胆总管切开取石一期缝合治疗胆总管结石安全、有效。值得广泛应用推广。 　　关键词：胆管结石 一期缝合 腹腔镜 胆道镜 　　Abstract： Objective ：clinical research of primary suture of the incision on common bile duct in common bile duct stones; Methods ：An incision of 15mm was made on the common bile duct in 75 patients who had indication for exploration from Jan 2013 to June 2014 then the choledochoscope was placed into common bile duct through this incision . The incision was directly sewed up after the exploration with 4-0 or 5-0 absorbable suture. Results ：Stone were all dislodgment.74 patients were curried and 1patient was appearance bile leakage，but by treat of conservation was curried. The average operating time？of open group was 103 minutes and laparoscopic group was 92 minutes， The mean duration of postoperative hospitalization was of open group was 14 - 19days and laparoscopic group was 4 days. The Peritoneal drainage？f postoperative hospitalization were 4-7 days andaparoscopic group was 3 days. 70 patients were followed up with B- mode ultrasonography for 6 months. It was found that no biliary colic， choloplania， no calculus remain or palindromia and no common bile duct stricture. Conclusion Strictly surgical indications and contraindications of the common bile duct under a suture is a safe and effective selection of operation.worth widely promoted 　　Keywords：Common duct stones primary suture abdominoscope choledochoscope 　　既往胆总管切开取石探查后常规放置T型管引流，胆汁外引流造成电解质紊乱，术后肠功能恢复减慢。而且代管时间较长。一般要在术后14 -30天后造影或彩超检查后才能拔除，患者住院时间长，花费高，且给生活带来不便。随着胆道外科技术的进步以及生物相容性缝合线的应用， 胆总管切开探查一期缝合胆管在临床广泛应用。为了在基层医院广泛推广。本文对我院2013年1月-2014年6月进行的胆总管结石患者进行胆总管切开取石，一期缝合治疗。取得良好效果。现报道如下： 　　1 资料和方法 　　1.1病例资料纳入标准： （1）胆总管结石，