胆总管切开取石探查后一期缝合的研究

目的探讨胆总管切开术一期缝合的可行性及治疗效果。方法选择性对69例术前经过B超、CT或ERCP等检查，并且术中经过胆道镜探查，检查明确无肝内胆管结石，胆总管＼肝总管无残留结石，胆道镜能顺利通过Oddis括约肌；胆总管内径大于或等于10mm，胆汁清，胆管壁炎症轻的胆总管结石等患者行胆总管一期缝合。结果69例中术后发生胆漏3例，经引流等对症处理后治愈，术后住院3-14d，平均6．5d。结论在胆总管切开取石探查，术中选择性应用胆总管一期缝合，可缩短住院时间，但对于腹腔镜下胆总管切开，经胆道镜检查，胆总管一期缝合可取得良好效果，患者的痛苦轻，体现微创外科的特点。

Study on the application of primary suture after choledochotomy for stone removal and exploration

Objectives To explore the feasibility and efficacy of primary suture after choledochotomy for stone removal and exploration.Methods Sixty-nine cases of choledocholith were chosen for primary suture after choledocholithotomy.The selective criteria were:no intrahepatic biliary calculi by preoperative CT,B-ultrasonography(B-US)and intraoperative B-US or choledochoscopy;no residual choledocholith;Choledochoscope and choledochal sound larger than F10 could pass Odd's sphincter;slight inflammation on the wall of common bile duct(inner diameter>10 mm)with clear bile secretion.Results Among 69 patients,there were 3 cases of bile leakage.All of them recovered after conservative treatment.Conclusion Selective primary suture after choledocholithotomy may shorten the duration of hospital stay and relieve pain of the patients.Laparoscopic common bile duct exploration with primary closure of bileduct is a safe and feasible minimally invasive operation,While it has a great advantage of minimally invasive surgery.