腹腔镜胆总管切开取石术后胆道引流方法的改进

胆总管切开取石术后能否一期缝合的争论由来已久[1],一般认为胆总管一期缝合前须放置适当的胆道引流。我们在临床工作中探索制作了一胆道内置引流管,在腹腔镜胆总管切开取石术后用胆道内置管引流,胆总管一期缝合,效果较满意[2],现将我们的经验介绍如下。1资料与方法1.1临床资料

The improvement in common bile duct drainage after laparoscopic common bile duct exploration

Objective To evaluate the therapeutic effects of endobiliary tube drainage(EBTD) after laparoscopic common bile duct exploration,in order to ensure the safe primary closure of the common bile duct.Methods Patients were selected according to predetermined criteria.After laparoscopic common bile duct exploration,an endobiliary tube was inserted,afterwards the common bile duct was closed.EBTD's clinical efficacy was compared with T tube drainage(TTD).Results From September 2000 to October 2005,156 eligible patients were enrolled into the study,of wich EBTD goup 107 and TTD group 49.All operations were done under the laparoscopy,with no patients transferred to open operation and no death.In EBTD group,the mean average operation time was 98 minutes(45-237 minutes);bile leakage occurred in 4 patients,which stopped spontaneously on the 2nd to 4th postoperative day;abdominal bleeding occurred in 1 patients and emergency laparoscopic hemostasis was needed;the endobiliary tube could not be discharged spontaneously in 3 cases and were removed under duodenoscopy,average hospital stay was 4.8 days after operation.In TTD group,the average operation time was 119 minutes(77-198),bile leakage occurred in 3 patients,which stopped spontaneously on the 2nd to 6th postoperative day;average hospital stay was 8.4 days after operation.In 1 month to 4 years follow-up period,neither retained stones nor biliary stricture were found in any patients.Conclusion If indication could strictly controlled, laparoscopic common bile duct exploration with endobiliary tube drainage and primary closure of the duct is safe and effective.It can decrease hospital stay and further alleviate patients' suffering.