腹腔镜胆总管探查一期缝合669例报告

Laparoscopic Common Bile Duct Exploration and Primary Suture in 669 Cases

目的探讨腹腔镜胆总管探查一期缝合术的临床经验。方法1992年3月～2006年12月,我院实施腹腔镜胆总管探查一期缝合术669例(胆道镜取石术,液电碎石术,胆道狭窄扩张术,经胆囊管引流术,胆道内支架术)。结果手术成功643例(96.1%),胆漏17例(2.5%)经内镜鼻导管引流和腹腔引流治愈,胆道轻度狭窄2例(0.3%)无临床表现未处理,残余结石4例(0.5%)经术后内镜取石治愈,细导管滑脱2例(0.3%)经再次手术治愈,晚期胰头癌死亡1例(0.1%)。581例随访6～48个月,平均25.6月,无胆漏、胆管狭窄、胆道出血发生。结论严格掌握手术适应证,选择合适的病例,腹腔镜下胆总管探查一期缝合安全、有效、可行。

Objective To report our clinical experience on laparoscopic common bile duct exploration and primary suture. Methods From March 1992 to December 2006, 669 cases of laparoscopic common bile duct exploration and primary suture were carried out in our hospital. Cholangioseopic lithotomy, electrohydraulie lithotripsy, biliary dilation, bile duct drainage, or biliary stenting were performed on the patients. Results The surgeries were completed successfully in 643 of the 669 cases （96. 1% ）. Biliary leakage was observed in 17 （2.5%） cases after the operations, and was cured by nasobiliary and intra-abdominal drainage. 2 （0. 3% ） patients developed mild stenosis of the bile duct without showing any symptoms. 4 （0.5%） had residual stones and were cured by a second laparoseopie surgery. The fine duct fell off in 2 eases （0. 3% ） , and was re-fixed by a re-operation. 581 of the cases aehieved a 6- to 48-month follow-up （ mean, 25.6 months） , during the period, no patient developed biliary leak, and stenosis or hemorrhage of the common bile duct. Conclusion Laparoscopie common bile duct exploration and primary suture is safe and effective.