腹腔镜、胆道镜、十二指肠镜(三镜)同期手术扩大一期缝合术应用199例报告

Laparoscopy,choledochoscopy and duodenoscopy for treatment of extrahepatic bile duct stones and stenosis of papillory with primary closure of bile duct incision during the course of laparoscopy: a report of 199 cases

目的总结运用腹腔镜、胆道镜、十二指肠镜(三镜)同期手术治疗胆囊结石、胆总管结石和乳头狭窄,及扩大一期缝合术应用范围的经验。方法腹腔镜下行LC、胆总管切开、胆道镜取石、液电碎石,经腹胆道镜钳道插入输尿管导管或斑马导丝至十二指肠腔,经口十二指肠镜行乳头切开术,一期缝合胆总管切口。结果扩大一期缝合术应用范围199例,术中成功切除胆囊和取净胆总管结石199例。197例乳头狭窄切开成功,直接施行一期缝合术,2例乳头狭窄切开失败者改为T管引流术。术后发生胰腺炎3例;发生胆漏4例,经腹腔引流管引流治愈;无肠穿孔、胆管穿孔、大出血、重症胰腺炎等并发症,无死亡。结论选择适宜的病人,采用三镜同期手术扩大一期缝合术应用范围是可行、有效和安全的。

Objective To summarize clinic experience of laparoscopy,choledochoscopy and duodenoscopy for treatment of extrahepatic bile duct stones and stenosis of papillory with primary closure of bile duct incision during the course of laparoscopy. Methods To accomplish LC and common bile duct exploration firstly,through ureteric catheter and zebra guidewire of common bile duct incision into duodenum,through duodenoscopy via oral into the papillary of duodenum,these approaches were used to cut through the stenosis of papillory for electro-knife by pin-head-like. It was received the primary closure of duct incision. Results It was successful in 199 cases removing the gallbladder and the common bile duct stones. Papillotomy was successful in 197 with primary closure of bile duct incision out of 199 cases,two cases were shifted to T tube drainage. Three patients suffered from a slight pancreatitis. Bile leakage of primary closure of duct incision was cured by patent drainage in 4 cases. perforation of intestine and bile duct,bleeding,severe pancreatitis and death were found in all of the patients. Conclusion If patients are suitable,LEST with primary closure of bile duct incision is safe and effective.