胆道镜小切口胆总管探查1120例临床应用

Miniature incision in choledochoscopy for common bile duct:a report of 1120 cases

目的探讨用胆道镜在小切口探查胆总管的疗效。方法右上腹肋缘下4～6cm长切口开腹,经切开胆总管放入胆道镜检查及取石1015例,经胆囊管放入胆道镜检查及取石105例。胆总管内置T管引流806例,一期缝合胆总管314例。结果1120例中838例(74.8%)胆总管结石被清除,阴性探查243例(21.7%),T管引流者术后发生残余结石21例(1.9%),胆总管末端损伤15例(1.3%),其中术后1例并发消化道大出血死亡,漏胆12例(1.1%)。314例(28.0%)胆总管一期缝合者无1例漏胆及胆管狭窄。结论小切口加胆道镜技术探查胆总管是安全可行的,严格选择适应证可确保一期缝合胆总管的安全。

[Objective] To evaluate the effect of the minature incision in eholedoehoscopy for common bile duct （CBD）. [Methodsl The incision was 4-6 cm of the right costal margin. Choledochoscopy was performed with incisions on CBD in 1 015 cases and cystic duct in 105 cases. CBD exploration with primary suture was performed in 314 cases, and the plus T-tube drainage in 806 cases. [Results] The CBD stones were removed in 838 of 1120 patients （74.8%）. 243 cases were negative （21.7%）. With a T tube placement for remain CBD stones of 21 cases （1.9%）. 15 casea（ 1.3%）of complication at intraoperative of injure iatrogenic on the end of common bile duct, 1 case died of complication bleeding massive in digestive tract, and 12 cases were （1.1%） with leak bile. 314 cases （28.0%） not with primary suture CBD of leak bile and narrow. [Conclusion] The miniature incision for intervened flexible choledochoscopy exploration of the common bile duct is safe, and the primary suture CBD is safe as well.