胆管探查术后一期胆管缝合:一百三十多年的追求

胆管探查术(CBDE)是治疗肝内外胆管结石的经典手术方式,胆管内置T管外引流术(TTD)和一期胆管缝合术(PDC)是胆管切开后修复胆管的两种手段。复习早期文献可知,尽管1889年实施的第一例CBDE采用了PDC术式修复胆管,随之,人们也认识到了CBDE后PDC在安全性和微创性方面均优于TTD,疗效方面无明显差异。但直到现在,CBDE后修复胆管仍以TTD为主要手段,PDC并没有像早年预期的那样获得广泛应用,其技术规范尚未确立,PDC和TTD的适应证和禁忌证尚无明晰的界定。本文通过回顾PDC一百三十多年的发展历程,总结其在不同发展阶段的临床应用研究状况,对其未来发展趋势进行展望。

Primary duct closure following common bile duct exploration: a pursuit for 130 years

Common bile duct exploration(CBDE)is a classic procedure for cholelithiasis.T-tube drainage(TTD)and primary duct closure(PDC)are the two therapeutical methods for bile duct repairment.Based on the literature review,it’s indicated that although PDC was the method used to repair the cut bile duct in the first case of CBDE in 1889,then,people realized that PDC was superior to TTD in terms of safety and minimally invasiveness,and there was no significant difference in the effect of treatment,however,until now,TTD has still been the main method to repair bile duct after CBDE.PDC has not been widely used as expected in the past years.The indications and contraindications of PDC and TTD have not been clearly defined.This paper reviewed the development of PDC for more than one hundred and thirty years,and summarized the clinical application research status in different development stages,and looks forward to the future development trend.