胆道内置管引流在腹腔镜胆总管切开取石术中的临床应用

目的探讨腹腔镜胆总管切开取石术后以胆道内置管引流代替T管引流的安全性和可行性。方法对过去4年开展腹腔镜胆总管切开取石术后胆道内置管引流胆总管一期缝合病例进行回顾性分析，包括临床资料、术后并发症以及随访结果。结果自2000年9月～2005年6月共完成腹腔镜胆总管探查术166例，其中70例因肝内外多发性胆管结石或化脓性胆管炎、较严重的胰腺炎等放置T管引流外，其余96例术中确诊已取净结石、无胆道狭窄的患者放置内置管引流取代T管引流，胆总管一期缝合，无1例中转开腹，无1例死亡。放置内置管引流手术时间为45～237min，平均98min。术后胆漏4例，引流2～4d自止，无需特殊治疗；术后腹腔内出血1例，当日行再次腹腔镜手术结扎止血成功。内置管除3例不能自行排出，于术后1个月经十二指肠镜取出外，其余93例患者内置管均自行排出。随访3个月～4年均未发现胆道有关的并发症。结论腹腔镜胆总管切开取石术后内置管引流，能有效引流胆汁，防止胆道高压，保证了胆总管一期缝合的安全，避免了T管引起的并发症，大大减轻了患者的痛苦，适应于大多数胆总管结石患者。

Clinical pradice on laparoscopic common bile duct exploration with endobiliary drainage

Objective] To evaluate the security and feasibility of endobiliary tube drainage substitute T tube drainage and primary closure of the common bile duct after laparoscopic common bile duct exploration. Methods] In the past 4 years, we practised endobiliary tube drainage and primary closure of the common bile duct after laparoscopic common bile duct exploration in 96 patients, the clinical data, complications and follow up results were analyzed retrospectively. Results] 166 cases of laparoscopic common bile duct exploration have been performed from September 2000 to June 2005, in 70 cases the T tube were necessary because of intrahepatic numerous stones, suppurative cholangitis, severely biliary pancreatitis or biliary stenosis. The other 96 cases whose stones were completely removed were placed endobiliary tube drainage instead of T tube drainage with no conversion and no death, The mean duration of surgery was 98 minutes(45~237 minutes), bile leakage occurred in 4 patients, bile leak ceased spontaneous on the second to 4th postoperative day. Abdominal bleeding in 1 patients and needed an emergency re-operation laparoscopically for hemostasis. The endobiliary tube could not be discharged spontaneously in 3 cases and were removed by duodenoscopy. At 1 month to 3 years follow up, retained stones or biliary stricture were not found in any patients. Conclusion] The laparoscopic common bile duct exploration with endobiliary tube drainage can effectively drain the bile, preventing the biliary hypertension after operation, assuring the primary closure of the common bile duct and avoiding the complications associated with T tube placement. The clinical application is safety and effective in most patients with choledocholithiasis.