一种胆囊管引流新方法在胆总管探查中的应用

A New Method of Biliary Cystic Duct Drainage for Common Bile Duct Exploration

目的：探讨胆总管切口Ⅰ期缝合、用自制硅橡胶环固定胆囊管引流和早期拔管的可行性。方法：回顾分析4例胆总管切开取石Ⅰ期缝合、自制硅橡胶环固定胆囊管引流和5d后拔除引流管的患者的临床资料。结果：4例手术均成功，术后第1天胆道内压力最高为20cmH2O，并逐渐下降，至第5天为12～13cmH2O，经造影后拔管，无胆漏腹痛等并发症。结论：硅橡胶环能严密闭锁胆囊管残端，经胆囊管引流降低围手术期暂时性胆道内高压，可避免胆总管探查切口Ⅰ期缝合后胆漏的发生。

Objective：To explore the feasibility of common bile duct exploration with primary suture, drainage of the cystic duct stump using self-made silicon ring fixation and early withdrawal of the drainage. Methods： The clinical data of 4 cases of choledocholithotomy with primary suture, drainage of the cystic duct stump using self-made silicon ring closure and withdrawal of drainage on day 5 post-operation were analyzed retrospectively. Results： The method used in 4 cases was successful. The maximal intraductal pressure on day 1 post-operation was 20 emil20, and then declined gradually, reaching 12 - 13 cmH2O on day 5. The drainages were removed after routine radiography. No complications such as biliary leakage or abdominal pain were observed. Conclusion： The self- made silicon ring appeared to securely lock around the cystic duct. Drainage of cystic duct showed efficacy in reduction of transient ductal hypertension after operation to avoid biliary leakage in common bile duct exploration with primary suture.