腹腔镜胆总管探查术中即时缝合胆总管切口427例体会

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1992年6月至2003年12月，我们运用腹腔镜胆总管探查即时缝合术(胆道镜取石术，扩张术，经胆囊管细导管外引流术，胆总管支架内引流术)，对427例病人进行治疗。结果405例手术获成功(94．8％)，4例残石经内镜取石治愈，4例残石内镜未取净，11例胆漏经腹腔引流管或内镜鼻胆管引流治愈，2例细导管脱落，1例胰头癌术后15d死亡。其他并发症均经非手术综合疗法治愈。结论选择合适病例，腹腔镜胆总管探查即时缝合术是安全可行的。

Primary closure of bile duct incision of laparoscopic bile duct exploration 427 patients

Objective To summarize the method of applying laparoscopic choledochotomy with primary suture for the treatment of choledocholithiasis and bile duct stenosis. Methods From Jun 1992 to Dec 2003, 427 patients were received the therapeutical procedures, i.e. laparoscopic common bile duct exploration was first adopted in order to clear the stones with choledochoscopic exploration, then followed the primary closure of duct incision direct or after balloon dilation, fine duct external drainage via cystic duct , internal drainage of biliary endoprosthesis and stent. Results 405 out of 427 patients had obtained successful duct clearance, or the dilation of the stenosis to reach the expected expansion, easy and smooth internal drainage of biliary endoprosthesis and stent without bile leakage. 4 patients had residual stones then cured with endoscopic sphincterotomy or papillary balloon dilation. 4 patients had residual stones then no cured with endoscopy. 11 patients had bile leakage cured through conservatively. 2 patients had fallen off fine duct via cystic duct cured through to place again fine duct via cystic duct or T shape duct with laparoscopy. One patient of pancreatic head carcinoma died in MSOF postoperation 15 days. Conclusion Eventually it was safe and effective for some patients who had completed successful duct clearance and the dilation of the stenosis to reach the expected expansion adopted bile duct incision primary closure in laparoscopic bile duct exploration.