腹腔镜胆总管切开探查术5 0临床分析

目的探讨腹腔镜胆总管切开探查手术的方法与优缺点。方法选择胆管结石或胆道蛔虫病患者行腹腔镜胆总管切开探查术。结果本组50例患者中48例术中分别取出直径为0.6～2.9cm的结石1，～11枚，2例患者术中分别取出死蛔虫1、2条。有6例患者因结石嵌顿或取石网故障，术中无法取净结石，其中2例肋缘下作—6cm小切口开腹取净，4例术后经T管窦道取净结石，1例患者中转开腹手术止血。手术时间117.2(45～180)min，术后6.8(3～12)d出院，30例患者术后置T管引流。未置T管即时缝合胆总管20例，其中1例出现轻度胆汁渗漏。结论腹腔镜胆总管切开探查取石术是较安全的，患者术后痛苦小、恢复快、住院期短，部分患者不置T管即时缝合胆总管更加体现微创效果o

Clinical analysis of 50 patients with laparoscopic common bile duct exploration

Objective To study how to manage laparoscopic common bile duct (CBD) exploration.Methods Laparoscopy was performed on 48 patients with CBD stones and 2 with biliary ascariasis. An in- cision from which fiberoptic endoscopy could be inserted to the biliary duct was made in the anterior wall of the CBD. The stone and ascariases were removed by the forceps or basket. Results The span of operation timewas 117.2 (45～180) min. The average length of postoperative stay were 6. 8 (3～12) days. 1～11 calculi(0. 6～2. 9 cm) in 48 cases and 1～2 ascariases in two case were taken out. 4 cases had a retained stone. 2cases had converted operation. The 20 cases of CBD were primary sutured after removing stones or ascariases.There were no death record. One patient who received biliary tract operation 20 years ago was converted into open hemostasis. One case with one-layer-suture had mild biliary fistula and was cured by means of con-servative treatment. Conclusion Our experiences revealed that laparoscopic common bile duct exploration issafe and efficient. It has been shown that primary suture of CBD in some patients is safe with advantage of shortpostoperative stay, mild pain and rapid recovery, and the two layer's suture of CBD can avoid the developmentof biliary fistula.