腹腔镜胆总管探查改良胆管支架引流与T管引流的比较

Comparative study of modified biliary stent and T-tube drainage in laparoscopic common bile duct exploration

目的探讨腹腔镜胆总管探查(LCBDE)胆管引流的新术式。方法胆总管结石患者在行LCBDE时根据取石难易、结石性状、胆管炎症程度采用T管引流或改良支架引流。后者是先将导丝经胆管镜操作孔置入十二指肠,再将支架套住导丝用推送管推入胆总管及十二指肠腔内,胆总管切口一期缝合。结果同期成功完成的62例LCBDE中,放置改良支架33例,放置T管29例;支架和T管的平均置管时间分别为29.6min和42.4min(P<0.01),术后平均住院时间分别为5.7d和9.5d(P<0.05),两组术后近期并发症及血清胆红素水平无明显差异。全部支架自行脱落并随粪便排出,支架排出时间为(13.6±2.55)d。结论在LCBDE时,对明确结石已取净、无明显絮状物者应首选改良胆管支架引流。

【Objective】To explore an optimal way of biliary drainage in laparoscopic common bile duct exploration (LCBDE). 【Methods】During LCBDE in patients with common bile duct stones, a modified biliary stent or T-tube was selected for biliary drainage. The selection was based on difficulty of stone extraction, stone status and severity of the inflammation. The stent was pushed into the distal part of the bile duct and lumen of the duodenum over the guide wire inserted through the choledochoscope. The CBD incision w...