腹腔镜胆总管探查即时缝合术的临床应用--附403例报告

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 从1992年6月-2003年5月,运用腹腔镜胆总管探查即时缝合的手术方式(胆道镜取石术、扩张术、细导管引流术、支架术)对403例病人进行治疗。结果 381例手术获成功(94.5％),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例胆囊管细导管脱落,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 by laparoscopic bile duct exploration in 403 patients

Objective To summarize the experience of applying laparoscopic choledochotomy with primary suture for the treatment of choledocholithiasis and bile duct stenosis. Methods From Jun 1992 to May 2003, 403 patients 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 by the primary closure of duct incision after balloon dilation, drainage via cystic duct, drainage of biliary endoprosthesis and stent placement. Results The operation was successful in 381 out of 403 patients. 4 patients with residual stones were cured with endoscopic sphincterotomy or papillary balloon dilation. 4 patients with residual stones were not cured with endoscopy. 11 patients with bile leakage were cured through conservative treatment. Fine duct via cystic duct or T shape duct with laparoscopy in 2 patients with fine duct fallen off were performed again. One patient with pancreatic head carcinoma died of MSOF postoperation 15 days. Conclusions Primary closure of bile duct incision by laparoscopic bile duct exploration is safe and effective for some patients.