胆总管探查切口一期缝合内支架引流术

Primary closure of choledochostomy with antegrade biliary stent drainage after common bile duct exploration

目的 探讨胆总管探查术中放置改良内支架及胆总管切口一期缝合的方法及效果。方法 对39例胆囊结石合并胆总管结石的患者分别采用开腹及腹腔镜下胆囊切除及胆总管探查术，清除结石后，置入8FJ型支架管，将其远端通过导丝放入十二指肠。支架管近端用快吸收线固定于胆管壁。胆总管切口一期缝合关闭。结果全部支架管在术后随粪便排出，平均排出时间为13（10-18）d。3例术后血清淀粉酶短暂升高。无胆漏、堵管、提前脱管、导管滞留、导管退入胆道等并发症发生。结论胆总管探查术中经胆道镜和导丝向胆管和十二指肠内放置自行脱落J型支架管方便、易掌握，是安全、有效的胆道引流方法。置放内支架管可放宽胆总管切口一期缝合的指征，并可减少T型管引流的相关并发症。

Objective To explore the method and effect of primary closure of choledochostomy with placement of a modified biliary stent after common bile duct exploration. Methods Open or laparoscopic common bile duct exploration was done in 39 patients with both gallbladder and common bile duct （CBD） stones. After extraction of stones, an 8 F J- stent （ pigtailed ） was placed in the CBD and into the duodenum over a guide wire. The proximal end of the stent was secured to the CBD wall with rapidly absorbable suture. The CBD incision was primarily closed. Results The stent dislodged and was discharged with stool at the 13th （10-18） postoperative day Three patients developed transient hyperamylasemia in the immediate postoperative period. None of the patients had complications of bile leak, stent occlusion, early stent dislodgement, or stent retraction into the CBD. Conclusions Placement of a self-release biliary J-stent in CBD and into the duodenum during common bile duct exploration is easier to manipulate with the help of eholedochosepe and guide wire. It is safe and cost-effective, therefore, it can expand the indications for primary closure of CBD incision, and reduce the complications related to T-tubes.