腹腔镜胆总管切开取石一期缝合术64例报告

目的探讨腹腔镜胆总管切开取石一期缝合的可行性与适应证。方法回顾性分析行腹腔镜胆总管切开取石一期缝合治疗胆总管结石64例临床资料,其中慢性胆囊炎、胆囊结石伴胆总管结石54例,急性结石性胆囊炎伴胆总管结石4例,单纯性胆总管结石6例,合并胰腺炎6例。结果64例全部获得成功,无一例中转开腹。全组腹腔镜手术时间50~120 min,平均(68.5±15.6)min,取石时间10~65 min,平均(28.5±10.6)min,术中出血20~120 ml,平均(25.4±16.7)ml,肛门排气恢复时间6~52 h,平均(12.5±9.3)h。手术并发症发生率为7.8%(5/64):胆漏2例,腹腔引流管引出胆汁量20~80 ml/d,经充分引流后痊愈;切口感染2例,脐部切口疝1例,无腹腔内脏器损伤及大出血等严重并发症。住院时间6~18 d,平均(7.2±2.1)d。均获随访,时间3~12个月,平均(7.3±1.9)个月,经B超或MRCP检查均未见结石残留及胆管狭窄。结论只要掌握好适应证,腹腔镜胆总管切开取石一期缝合术治疗胆总管结石是一种安全可行的手术方法。

Primary Suture of the Common Bile Duct after the Laparoscopic Biliary Exploration and Lithotomy(A Report of 64 Cases)

Objective To explore the feasibility and indications of the primary suture of the common bile duct after laparoscopic biliary exploration and lithotomy.Methods The clinical data of 64 cases with common bile duct stones was analyzed retrospectively,in which 54 of chronic cholecystitis,cholecystolithiasis,and secondary choledocholith,4 of acute cholecystitis,cholecystolithiasis,choledocholith,and 6 of simple choledocholith.There were 6 cases complicated with acute pancreatitis.All the 64 cases underwent laparoscopic cholecystectomy,laparoscopic biliary exploration and lithotomy,and then the common bile duct was sutured without T tube implantation.Results All patients were operated successfully without conversion to open surgery.The operation time was（68.5±15.6）minutes.The lithotomy time was（28.5±10.6）minutes.The operative bleeding volume was（25.4±16.7）ml.The first evacuating time after operation was（12.5±9.3）hours.There were 5 cases（7.8%） suffered from complications such as bile leakage（2 cases）,wound infection（2 cases）,umbilical incisional hernia（1 case）.There was no serious injury or bleeding during the operation.All the cases were discharged smoothly after（7.2±2.1） days hospital stay.All the cases were followed up for 3 to 12 months without stone residual or bile duct stenosis by ultrasonic and MRCP examination.ConclusionThe primary suture of the common bile duct after biliary exploration and lithotomy is a safe and feasible surgical method in the suitable patients.