腹腔镜胆总管切开探查并一期缝合152例临床分析

Primary closure after larparoscopic treatment for choledocholithiasis

目的探讨腹腔镜胆总管探查取石一期缝合术的可行性及手术方法和技巧.方法对1997年9月～2003年1月共152例腹腔镜联合纤维胆道镜行胆总管切开探查一期缝合的患者资料进行回顾分析.结果手术时间平均79.5 min,术中出血平均28.3ml,术后肛门排气恢复时间平均14.5 h.并发症发生率为6.6%(10/152),其中胆漏7例经充分引流治疗痊愈;切口感染2例;脐部切口疝1例.住院时间平均7.3 d.经随访3个月～5年未见结石残留及胆管狭窄.结论对胆总管直径在1.0 cm以上、确认结石已取尽、胆总管内胆汁清亮、黏膜光滑无明显炎性充血及狭窄者,在作好围手术期处理的前提下,一期缝合是腹腔镜胆总管探查取石术后有效处理胆管切口的方法.

Objective: To explore the feasibility of larparoscopic primary duct closure technique in the treatment of choledocholithiasis. Methods: Between September 1997 and January 2003, 152 patients who underwent primary duct closure after larparoscopic common bile duct(CBD) exploration were reviewed. Results: All operations succeeded and the operative time was (79.5±11.0)min, while the intraoperative blood loss was (28.3±14.1)ml. Normal gastrointestinal activity returned in (14.5±9.8) hours. Postoperative complications appeared in 10 (6.6%) patients, 7 cases were self-limiting bile leakage in the early postoperative period, 2 for wound infections and 1 for incisional hernia. The hospital stay after surgery was (7.3±1.8) day. No stenosis and stone recurrences were founded with a follow-up within 0.2 to 5 years. Conclusion: Primary duct closure after laparoscopic choledochotomy is safe and effective if appropriate indications (such as no residual stones, little inflammation and no strictures in the CBD, accompanying with the diameter of CBD above 1.0 cm) and measures have been taken.