腹腔镜胆总管探查胆管一期缝合(附302例临床分析)

Primary duct closure after laparoscopic common bile duct esploration: a retrospective study of 302 cases

目的:探讨腹腔镜胆总管探查胆管一期缝合的方法、适应证和禁忌证。方法:回顾总结一期胆管缝合302例的临床资料。术后3月作静脉胆道造影或B超随访。其适应证是（1）探查阴性;（2）胆管结石取净,胆管下端通畅,无或轻中度胆管炎;（3）重症胆管炎经鼻胆管引流好转。禁忌证是（1）肝内胆管结石;（2）胆总管结石未取净;（3）重症胆管炎;（4）胆总管下端通不佳。结果:279例结石取净;20例探查阴性。发生并发症15例（5.0％）,死亡1例。平均随访4.6年（3月～9年）,无胆管狭窄。结论:多数患者腹腔镜胆总管探查后可行胆管一期缝合。

Objective: To explore the skill, indication and contraindication of primary closure in laparoscopic common bile duct exploration(LCDE) .Methods: A retrospective study of 302 cases of primary duct closure after laparoscopic choledochotomy had been done.Primary duct closure was performed when:(l)Negative bile duct exporation developed. (2)The clearance of bile duct achieved completely, and the patients were convinced absent of heavy cholangitis, on obstruction of distal of common bile duct by intraoperative choledochoscopy. (3) Heavy cholangitis improved after naso-clolangiostomy,postoperative endoscopic sphincterotomy(ES)was recommended when retained bile duct stone or papillary stenosis. Intravenous cholangiography (IVC) or ulerosound was required 3 months after surgery. Results: 279 case had completed duct clearance successful 3 patients with retained duct stone and 2 patients with papillary stenosis accepted postoperative ES. 20 cases had negative duct exploration. Morbidity rate was 5.0%. There was one death (0.3 % ) , and no duct stricture. Conclusions: Primary duct closure after laparoscopic choledochotomy is safe and effective for more than half patients with choledocholithiasis.