腹腔镜胆总管切开取石术后胆道引流方法的改进

The improvement in common bile duct drainage after laparoscopic common bile duct exploration.

目的 为确保胆总管一期缝合的安全，在腹腔镜胆总管切开取石胆总管一期缝合前放置自制的胆道内置管引流，探讨其临床疗效。方法 按一定的稿例筛选条件，在腹腔镜胆总管切开取石术后放置自制胆道内置管引流，胆总管一期缝合，分析其临床疗效，并与同期符合相同条件行T管引流术的患者对照。结果 自2001年9月至2005年10月共156例患者符合筛选条件，其中107例患者放置胆道内置管引流，胆总管一期缝合，其余49例仍按传统方法放置T管引流，全部病例均在腹腔镜下完成手术，无一例中转开腹，无一例死亡。内置管引流组手术时间为45—237min，平均108min，术后胆漏4例，引流2—4d自止，术后腹腔内出血1例，当日行再次腹腔镜手术结扎止血成功，内置管不能自行排出3例，于术后1月经十二指肠镜取出，术后平均住院4．8d。T管引流组手术时间77—198min，平均119min，术后出现胆漏3例，经保守治疗于术后2—6d自止，术后平均住院时间8.4d。两组患者随访3月-4年均未发现胆道有关的并发症。结论掌握一定的适应证，腹腔镜胆总管探查术后放置胆道内置管引流安全有效，缩短了住院时间，进一步减轻了患者的痛苦。

Objective To evaluate the therapeutic effects of endobiliary tube drainage （EBTD） after laparoscopic common bile duct exploration ,in order to ensure the safe primary closure of the common bile duct. Methods Patients were selected according to predetermined criteria. After laparoscopic common bile duct exploration, an endobiliary tube was inserted, afterwards the common bile duct was closed. EBTD＇s clinical efficacy was compared with T tube drainage （TTD）. Results From September 2000 to October 2005, 156 eligible patients were enrolled into the study, of wich EBTD SOUp 107 and TTD group 49. All operations were done under the laparoscopy, with no patients transferred to open operation and no death. In EBTD group, the mean average operation time was 98 minutes （45 -237 minutes） ; bile leakage occurred in 4 patients, which stopped spontaneously on the 2nd to 4th postoperative day; abdominal bleeding occurred in 1 patients and emergency laparoseopie hemostasis was needed ; the endobiliary tube could not be discharged spontaneously in 3 cases and were removed under duodenoscopy, average hospital stay was 4.8 days after operation. In TI＇D group, the average operation time was 119 minutes （77 - 198 ）, bile leakage occurred in 3 patients, which stopped spontaneously on the 2nd to 6th postoperative day ; average hospital stay was 8.4 days after operation. In 1 month to 4 years follow - up period, neither retained stones nor biliary stricture were found in any patients. Conclusion If indication could strictly controlled, laparoscopic common bile duct exploration with endobiliary tube drainage and primary closure of the duct is safe and effective. It can decrease hospital stay and further alleviate patients＂ suffering.