腹腔镜胆总管探查即时缝合术434例临床应用体会

Application of primary closure of bile duct in laparoscopic bile duct exploration:a report of 434 cases.

目的总结运用腹腔镜胆总管探查即时缝合术的治疗经验。方法自1992年3月至2004年3月,对434例病人施行腹腔镜胆总管探查即时缝合术(胆管镜取石术,扩张术,细导管引流术,支架术)。结果412例手术获成功(95%),4例残石经内镜取石治愈,4例未取净,11例胆漏经腹腔引流管或内镜鼻胆管引流治愈,2例细导管脱落,1例胰头癌术后第15天死亡。其他并发症均经非手术疗法治愈。结论选择合适病例,腹腔镜胆总管探查即时缝合术是安全可行的。

Objective To summarize the experience on laparoscopic choledochotomy with primary suture for the treatment of choledocholithiasis and bile duct stenosis.Methods From June 1992 to March 2004,434 patients received the therapeutical procedures,i.e.,laparoscopic common bile duct exploration was first adopted in order to clear the stones with choledochoscopic exploration.Then the primary closure of duct incision directly or after balloon dilation,fine duct drainage via cystic duct,drainage of biliary endoprosthesis and stent were followed.Results Four hundred and twelve out of 434 patients had obtained successful duct clearance.Four patients with residual stones were cured by endoscopy.Four patients still had remainders.Eleven patients with bile leakage were cured conservatively.Two patients with fallen-off fine duct via cystic duct were cured through replacing fine duct via cystic duct or T shape duct with laparoscope.One case of pancreatic head carcinoma died of MSOF on postoperative 15th day.Conclusion It is safe and feasible for proper patients to be performed primary closure of bile duct in laparoscopic bile duct exploration.