腹腔镜胆总管切开取石术后引流与非引流的临床探讨

Discussion on the Drainage/Non-Drainage of Bile Duct after Extraction of Choledoch Stone with Celoscope

目的总结腹腔镜联合纤维胆道镜胆总管切开取石行内引流、"T"管外引流与I期缝合的临床适应证。方法应用腹腔镜及纤维胆道镜技术治疗胆总管结石患者,行胆总管切开取石,胆总管内置入"内引流管","T"管以及一期缝合并观察疗效。结果131例腹腔镜手术全部成功,手术时间90～210min,其中行"T"管外引流41例,一期缝合90例。全组发生胆漏3例,8例术后残留肝内胆管结石,均带"T"管出院,于术后6周回院行胆道镜取净结石治愈。全组均无胆道狭窄、大出血、腹腔感染。术后第2天进流质饮食并下床活动,平均住院7.5d。结论只要严格掌握适应证和熟练的腹腔镜操作技术,胆总管切开取石术后一期缝合是值得推广的。

Objective To summarize the clinical indications of extraction of choledoch stone with celoscope and fibre bile duct scope. Methods Celoscope and fibre bile duct scope were used during the operation for choledoch dissection, placing intra-drainage tube or T-tube, and primary suture. Results All 131 cases celiscopic operations were successfully performed in which 41 cases had T-tube extra-drainage and 90 cases had primary suture. Operation time was 90 to 210 minutes. 3 cases developed bile leakage and 8 cases had residual bilestones after the operation. All patients could have liquid diet 1 day after surgery. The average time stayed in the hospital was 7.5 days. Conclusion Understanding the clinical indications and technical skill of suture are essential for the extraction of stone by choledoch dissection.