腹腔镜胆囊切除并胆总管探查术胆囊管入路法347例临床总结

目的探讨腹腔镜胆囊切除并胆总管探查术中行胆囊管入路一期缝合预防胆道损伤及胆管狭窄的临床意义。方法 2009年1月至2014年4月北京军区总医院肝胆外科应用腹腔镜胆囊管入路法行胆囊切除及胆总管探查一期缝合术347例,对其临床资料进行分析。结果以胆囊管为解剖学标志,顺利显露胆囊壶腹部、胆囊管及胆总管,以胆囊管与胆总管移行区为胆总管探查入路,均成功进行了腹腔镜胆囊切除及胆总管探查术,并行胆总管一期缝合,术中未发生血管、胆管损伤,术后随访8~24月,未发现胆管狭窄。结论在腹腔镜胆囊切除及胆总管探查术中,采用胆囊管入路法,通过胆囊管与胆总管移行区行胆总管探查一期缝合术是一种安全、可行的方法,可有效避免胆道损伤及胆管狭窄的发生。

Clinical significance of cystic duct access during laparoscopic cholecystectomy plus iaparoscopic common bile duct exploration with primary suture: a summary of 347 cases

【Abstract】〓Objective〓To explore the value through the cystic duct access to the prevention of bile duct injury and stricture of bile duct during laparoscopic cholecystectomy (LC) plus laparoscopic common bile duct exploration with primary suture. Methods〓The clinical data of 347 cases of LC plus laparoscopic common bile duct exploration with primary suture through cystic duct access performed from January 2009 to April 2014 in General Hospital of Beijing Command were analyzed. Results〓Based on the cystic duct access and dissection transition zone of cystic duct and common bile duct, the cholecystic ampulla, cystic duct, the bile common duct and the arteria cystica were to reveal. All the cases were operated with LC plus laparoscopic common bile duct exploration successfully without injury of blood vessel and bile duct. No stricture of bile duct were founded during 8-24 months of follow up. Conclusion〓The transition zone of cystic duct and common bile duct is the key landmark. Through the cystic duct and common bile duct transitional zone for exploration of common bile duct in primary suture is a safe, feasible, and it can effectively prevent the bile duct injury and stricture of bile duct.