腹腔镜胆总管探查即时缝合术832例报告

目的总结运用腹腔镜胆总管探查即时缝合术的治疗经验。方法从1992年6月至2008年4月，运用腹腔镜胆总管探查即时缝合术的手术方式，对832例患者进行治疗。结果785例手术获成功，4例残石经内镜取石治愈，4例残石内镜未取净，34例胆漏经腹腔引流管、腹腔镜、内镜或开腹引流治愈，2例输尿管导管脱落，2例术后出血，1例胰头癌术后死亡。其他并发症均经非手术综合疗法治愈。结论只要选择合适的病例，腹腔镜胆总管探查即时缝合术是安全可行的。

Primary closure after laparoscopic bile duct exploration: Report of 832 patients

Objective To summarize the experience in laparoscopic choledochotomy with primary suturing. Methods From June 1992 to April 2008 in the Second People's Hospital of Chengdu, 832 patients were subjected to the procedures, i.e. laparoscopic common bile duct exploration was first adopted to clear the stones with choledochoscopic exploration, then followed by the primary closure of duct incision direct or after dilation and fine duct external drainage via the cystic duct. Results The procedures were successful in 785 of the 832 patients. Four patients had residual stones, which were removed by endoscopic sphincterotomy. Four patients had residual stones, which were not removed under a endoscope. Thirty-four patients had bile leakage, which was cured through patent drainage, laparoscopiy, endoscopy and open abdominal operation. Two patients had fallen off the fine duct via the cystic duct , they were cured by placing the fine duct again via the cystic duct or T shape duct with laparoscopy. Two patients had hemorrhage. One patient with pancreatic head carcinoma died on postoperative day 15. Conclusions If patients are suitable, laparoscopic choledochotomy with primary closure is safe and effective.