胆总管探查后一期缝合的临床实践与研究

目的　探讨胆总管探查后一期缝合的合理性和可行性。　方法　对 1990年 1月～ 2 0 0 1年 6月间肝外胆管结石择期手术的病例、胆总管探查后一期缝合 2 15例与放置T管引流的 171例进行比较。　结果　一期缝合组和T管引流组术后分别有 9例和 5例腹腔引流液含胆汁 ,均未作特殊处理。一期缝合组术后平均输液 4 9d、平均输液量 9 1L、平均住院时间 10 0d ;与T管引流组的术后平均输液时间 7 3d、平均输液量 12 8L、平均住院时间 17 6d相比 ,差异有显著意义 (P <0 0 1)。同时T管引流组有 5例分别在术后 16、17、19、2 1、2 2d拔管后发生胆汁性腹膜炎 ,3例再手术。　结论　在经过严格选择的胆总管结石择期胆总管探查病例中 ,经术中胆道镜或胆道造影排除残石后 ,一期缝合可作为一种安全有效的术式。

Primary common bile duct closure after choledochotomy

Objective To investigate the rationality and feasibility of primary closure of the common bile duct after choledochotomy for common bile duct calculi. Methods From January 1990 to June 2001, 386 patients with the evidence of stones in the common bile duct underwent choledochotony. Among them, 215 received primary closure of the common bile duct (group A) and 171 T-tube drainage (group B). The patients with emergency operations were excluded. Intraoperative choledochoscopy or cholangiography was routinely performed to rule out the possibility of retained stones.The duct was meticulously stitched using 0/3 to 0/5 absorbent sutures for primary closure. A T-tube was placed in the subhepatic space in the patients of both groups. Results Postoperative bile leakage was seen in 9 patients of group A and in 5 of group B, respectively (P>0 05), and no reoperations were necessary. After surgery ,the average time and volume of transfusion was 4 9 days and 9 1 liters in group A, versus 7 3 days and 12 8 liters in group B (P<0 01). The patients in group B had a longer postoperative hospitalstay than the those in group A (average 17 6:10 0 days, P<0 01). T-tube removal resulted in bile peritonitis in 5 patients at day 16, 17, 19, 21 and 22 after surgery in group B,and 3 patients required repeated surgery. Conclusions Primary closure of the common bile duct after choledochotomy is safe, effective, and inexpensive in selected patients with common bile duct calculi, and should be regarded as an alternative procedure.