定时脱落的J形导管在腹腔镜胆总管探查一期缝合术中的临床应用（附45例报告）

目的：总结腹腔镜胆总管探查一期缝合术中放置定时脱落的J形导管行胆道内引流的治疗经验。方法：2005年5月至2007年12月,我们为45例胆囊结石合并胆总管结石患者行腹腔镜胆囊切除、胆总管探查术,胆道镜取石后,将8FJ形导管置入胆总管及十二指肠,并将导管近端用快速吸收薇乔线固定于胆管壁,胆总管切口原位缝合关闭。结果：45例手术均获成功,平均手术时间125min,术后住院4～9d,平均6.5d,术后平均14dJ形导管随粪便排出。2例术后血清淀粉酶短暂升高。无胆漏、胆道狭窄、残余结石、堵管、提前脱管、导管滞留、导管退入胆道等并发症发生。结论：腹腔镜胆总管探查取石术后,胆总管内放置定时脱落的J形导管,引流一期缝合胆管壁是一种安全可靠的方法,具有患者创伤小、痛苦轻、康复快、并发症少等优点,在胆总管结石手术中具有较大优势,值得推广。

Clinical application of time fall-off J-stent on laparoscopic common bile duct exploration with primary suture:with a report of 45 cases

Objective:To summarize the experience of placement of time fall-off J-stent on laparoscopic common bile duct exploration(LCBDE)with primary suture.Methods:From May 2005 to December 2007,45 cases with gallbladder and CBD calcalis were undergone laparoscopic cholecystectomy and LCBDE.After removal of calculi,a 8F J-stent was placed into CBD and the duodenum over the guide wire.The proximal end of the J-stent was secured to the CBD wall with the absorbable suture.The CBD incision was primarily closed by continuous suture.Results:All cases were operated successfully.The mean operation time was 125min,the average postoperative stay was 6.5(4-9)days.The J-stent fell off and was discharged with stool at the 14th postoperative day on the average.Most complications included 2 cases of transient hyperamylasemia in the immediate postoperative period.There were no complications of bile leak,bile duct stricture,retained stones,stent occlusion,early or late stent fall-off,stent retreat to the CBD and other complications.Conclusions:Laparoscopic common bile duct exploration with time fall-off J-stent drainage and primary closure of the duct is safe and effective with lesser operative trauma,less pain,quick recovery and low recurrence.It might be adopted widely for its obvious advantage on the result of common bile duct calculus.