腹腔镜胆总管探查术后胆道内置管引流胆总管一期缝合的临床应用

A Clinical Study on Laparoscopic Common Bile Duct Exploration with Endobiliary Drainage and Primary Closure

目的 探讨腹腔镜胆总管切开探查胆道内置引流管、胆总管一期缝合的临床应用可行性、安全性和有效性。方法 选用16F普通硅胶管制作胆道内置引流管，对过去5年开展腹腔镜胆总管切开取石术后胆道内置管引流胆总管一期缝合病例资料进行回顾性分析，并与同期放置T管引流的临床资料进行对照。结果 自2001年9月至2006年2月共156例术中明确无残余结石、无肝内胆管结石及胆道狭窄患者行腹腔镜胆道探查术，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。2组平均手术时间分别为115．2±26．7min、127．5±24．2min（P〈0，05），术后住院4．8±0．92d、8．4±1．48d（P〈0．05），术后平均输液量7278．5±1381、11270．2±2026ml（P〉0．05），平均住院费用8932．7±1553，6元、10242．9±1594．5元（P〈0．05），恢复日常工作时间14．44±1．89d、31．93±3．52d（P〉0．05）。2组术后肝功能的恢复、并发症发生率无明显差异（P〉0．05）。2组病人随访1～51月，平均28月，均未发现胆总管残余结石及其它胆道相关并发症。结论 腹腔镜胆总管切开探查后放置胆道内置管引流胆总管一期缝合是一种安全、有效、可行的胆道引流方法。

Objective To investigate the feasibility, safety and effetiveness on laparoscopic choledochotomy with endobiliary drainage and primary closure of the common bile duct. Methods The endobiliary drainage catheter was made by a 16F silicon-rubber tube, The clinical data of the patients who underwent laparoscopie common bile duct exploration with endobiliary drainage and primary closure were analyzed retrospectively and was compared with that of whom experienced T tube drainage during the past 5 years. Results During 2001-09/2006-02 there were 156 patients without introhepatie or retained stones and biliary stricture underwent laparoscopie common bile duct exploration, 107 of them with endobiliary tube drainage and primary CBD closure and the other 49 patients with T-tube drainage. The average operative time was 115.2±26. 7vs 127.5±24.2 minutes（ P 〈 0. 01 ） , postoperative fluid transfusion was 7 278. 5 ±1 381 vs 11 270. 2± 2 026 ml （ P 〈 0. 01 ）, the hospital expense was 8 180 ± 910 and 11 500±1 270 Yuan, （ P 〈 0.05 ）, the time to return routine social work was 14. 77±1.89 vs 31.93±3.52 d （ P 〈 0.05 ）. there were no significant difference between the two biliary drainage methods on liver function recovery and the complication rate, During 1 to 51 months（ average 28 months） follow up, no retained stones and biliary stricture were found in any patients. Conclusion Laparoseopie eholedochotomy with endobiliary catheter and primary closure of CBD is a safe, effective and feasible procedure for the management of eholedocholithiasis.