腹腔镜胆总管探查术(附30例报告)

Laparoscopic choledochotomy : with a report of 30 cases

目的:研究腹腔镜胆总管切开探查术,以扩大腹腔镜手术的范围。方法:在腹腔镜下行胆总管切开、探查、取石术,部分患者行T形管引流术,部分患者行胆总管Ⅰ期缝合术。结果:30例患者,手术成功29例,中转开腹手术1例,放置T形引流管9例,胆总管Ⅰ期缝合20例。手术平均120min,术后第1天可下床活动和进食,术后第6天出院,带T形管引流的患者术后4～8周拔管,无1例发生胆汁漏、胆道狭窄、胆道出血和残余结石。结论:腹腔镜胆总管探查术具有痛苦小、损伤轻、恢复快、脏器干扰少等腹腔镜手术的优点,又能与开腹手术相同切开胆总管取石,放置T形引流管和胆总管工期缝合,使部分胆管结石患者在不开腹的状态下得到满意治疗。

Objective:To study the laparoscopic choledochotomy and expand the scope of laparoscopic operation. Method: The patients were applied laparoscopic choledochotomy with exploration, partly with T - tube drainage and partly with primary suture. Results :0f the 30 cases,29 cases were operated successfully, 1 case changed to laparotomy,9 cases of T - tube drainage and 20 cases of primary suture. The average operation time was 120min, patients were able to move off bed and eat at the first day after operation and leave hospital at the sixth day after operation. Patients of T - tube drainage can be removed of the tube 4-8 weeks after the operation. No report of biliary fistula, stenosis of biliary tract, hematobiliary residual stone. Conclusion: The laparoscopic choledochotomy has many advantages such as litde suffering and injury, fast recovery and less disturbance of organs. And like laparotomy, it applies choledochotomy with exploration, partly with T - tube drainage, and partly with primary suture. Therefore it provides a satisfactory treatment for the patients of choledocholith without the use of laparotomy.