腹腔镜胆总管切开取石Ⅰ期缝合术48例临床体会

目的：探讨腹腔镜胆总管切开取石Ⅰ期缝合术的手术方法与临床价值。方法：回顾分析2010年1月至2012年5月胆总管结石患者的临床资料,其中48例行腹腔镜胆总管切开取石Ⅰ期缝合术（观察组）,69例行开腹胆总管切开取石＋T管引流术（开腹T管组）,52例行腹腔镜胆总管切开取石＋T管引流术（腹腔镜T管组）。对比分析3组手术结果。结果：观察组48例手术均获成功。手术时间90～200 min,平均（150±8.7）min;术中出血量30～50 ml,平均（25±4.1）ml。术后1～2 d排气并下床活动,4～6 d出院,平均（5±0.3）d。无胆漏、切口感染等并发症发生。与其他两组相比,患者术后康复快、切口疼痛轻、住院时间短、费用低。结论：腹腔镜胆总管切开取石Ⅰ期缝合术具有微创、康复快、切口疼痛轻、住院时间短等优点,但具有一定的操作难度,术者与助手需默契配合及较长的学习曲线。

suture The surgical experience of 48 cases of laparoscopic choledocholithotomy with primary

Objective：To investigate the surgical experience and clinical value of laparoscopic choledocholithotomy with prima- ry suture. Methods：The clinical data of patients suffered from choledocholitbiasis from Jan. 2010 to May 2012 were retrospectively ana- lyzed. 48 cases underwent laparoscopic choledocholithotomy with primary suture （observation group） ,69 cases underwent open choledo- cholithotomy T-tube drainage （open surgery T-tube group） and 52 cases underwent laparoscopic choledocholithotomy T-tube drainage （ laparoscopic T-tube group）. Results：All 48 cases in observation group were successfully operated. The operative time was between 90- 200 rain, the average was （150 ± 8.7） rain;the blood loss was 30-50 ml, the average was （25 ± 4.1 ） ml;the fart and ambulation ap- peared 1-2 days after operation. All patients were discharged from the hospital within 4-6 d, the average was （ 5-± 0.3 ） d. No incision infection or bile leakage occurred. Compared with the other two groups, the patients in observation group showed faster recovery, less pain and cost, and shorter hospital stay. Conclusions：Laparoscopic choledocholithotomy with primary suture has more advantages with minimal invasion, quick recovery, little pain, short hospital stay. However, the surgeon and his assistants need more tacit understanding and longer learning curve.