腹腔镜保胆取石并胆总管切开取石一期缝合术20例报告

Totally laparoscopic cholelithotomy for preservation of cholecyst and application of primary suture of common bile duct in laparoscopic bile duct exploration:with a report of 20 cases

目的:探讨完全腹腔镜保胆取石并胆总管切开取石一期缝合术的手术方法和应用价值。方法:总结2006年3月至2009年1月我院20例中完全腹腔镜保胆取石同时行胆总管切开取石一期缝合术的经验,胆囊结石合并胆总管结石患者20例,于胆囊切开取石后缝合胆囊;切开胆总管,用胆道镜取净结石后用4-0可吸收线胆总管一期缝合。结果:2例因结石较大且嵌顿于胆总管下端,难以取出,中转开腹。18例手术获成功,均一期缝合,术后发生胆漏2例,引流10～60ml/d,持续1～4d,术后3～7d拔除腹腔引流管。手术时间120～240min,平均(180±31)min。术后住院7～10d,平均(7.0±1.3)d。患者均治愈。随访1～32个月,无结石复发,胆囊收缩功能检测为20%～30%。结论:完全腹腔镜保胆取石术同时行胆总管切开取石一期缝合术治疗胆囊结石合并胆总管结石切实可行。

Objective： The purpose of this paper was to discuss the operative methods and application value of treating the cholecystolithiasis with laparoscope and choledochoscope for preservation of choleeyst and primary suture after common bile duct was explored and calculus was removed. Methods： The experience of 20 patients with cholecystolithiasis complicated choledocholith treated with laparoscope and choledochoseope between Mar. 2006 and Jan. 2009 was summarized. The bottom of gallbladder was incised with laparoseopic electrosurgical hook,then all the stones were removed, the incision of gallbladder were sutured with 3-0 absorbable suture by two-layers suturing method. The choledocholithotomy had been performed besides the cholelithotomy and primary closure with 4-0 absorbable suture by one-layer continuous suturing method after common bile duct was explored and calculus were removed. Results：The operation of 18 cases had been performed successfully with primary suture ,2 cases were converted to open operation because of incarceration of large calculus at lower end of common bile duct. Bile leakage occurred in 2 patients, which continued for 1-4d with amount of 10-60ml every day. It was cured with conservative treatment, the drainage tubes of abdomen had been pulled out on 3-7 days after operation. The operation time was 120-240 （180 ±31 ）min ,the postoperative hospital stay was 7-10 （7.0 ±1.3 ） days ; all the patients were cured. After 20 cases had 1-32 months follow-up, no case had stone recurrence, there was no complication, the test of contractibility of gallbladder were 20%-30%. Conclusions： Totally laparoscopic cholelithotomy plays an important role for preservation of gallbladder, and it is safe and feasible for proper patients to be performed primary suture of common bile duct in laparoscopic bile duct exploration and calculus removement.