胆总管探查后一期缝合的经验和认识

Experience in primary common bile duct closure after choledochotomy

目的探讨胆总管探查后一期缝合的经验和认识。方法对1990年1月至2004年6月因肝外胆管结石择期行胆总管探查后一期缝合的271例作一回顾性分析。所有病例不含肝内胆管结石,术中经胆道镜或胆道造影排除胆道残石并常规放置右肝下引流管。结果术后14例腹腔引流液含胆汁,均未特殊处理。术后平均住院8.73d。所有病例术后3个月内门诊 B 超复查,未发现胆道残石。216例(79.70%)获得远期随访,无一例发现肝外胆管狭窄。结论对经过严格选择的肝外胆管结石病例,胆总管探查后不应强调一律放置 T 管。术中精细操作和经术中胆道镜或胆道造影检查排除残石后,一期缝合可作为术式选择。

Objective To summarize the experience in primary closure of common bile duct following choledochotomy for common bile duct calculi. Methods From January 1990 to June 2004, 271 patients with the evidence of stones in the common bile duct received primary closure of the common bile duct after eholedoehotomy. Those patients underwent emergency operations were excluded. Intraoperative choledochoscopy or eholangiography were routinely performed to rule out the possibility of retained stones. The duct was meticulously stitched using 0/3 to 0/5 absorbent sutures for primary closure. A suction drainage strip was placed in the subhepatie space for all the patients. Results Postoperative bile leakage was seen in 14 patients and no reoperation was necessary. The average time of postoperative hospital stay was 8. 73 d. Ultrasound re-examination was performed for every patient in 3 months after operation and no common bile duet retained stones were found. The long-term follow-up in 216 patients （79.70%） showed no extrahepatic duct stenosis. Conclusions Primary closure of the common bile duct after choledochotomy is safe, effective and cheap in selected patients and should be regarded as an alternative procedure for common bile duct calculi.