胆总管探查选择性放置双肩猪尾巴内支架管引流术治疗胆总管结石26例

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

目的:探讨胆总管切开探查术中选择性放置双肩猪尾巴内支架管(以下简称支架管)及胆总管切口原位缝合的方法及效果。方法:对26例胆总管结石患者采用开腹手术,胆总管切开探查取石后,把支架管通过导丝将远端置入十二指肠,胆总管切口原位缝合。结果:术后支架管随粪便自行排出,平均排出时间为14(10～18)d,3例术后出现血清淀粉酶短暂性轻微升高。无胆瘘、堵管、提前脱管或支架管滞留胆管等并发症。结论:胆总管探查术中经导丝向胆总管和十二指肠内放置自行脱落的支架管既方便又安全,是有效的胆管引流的方法。放置支架管,胆总管切口原位缝合可减少放置"T"型管引流的相关并发症。

Objective： To explore the method and effect of primary closure of choledechostomy with placement of a modified biliary stent after common bili duct exploration. Methods： Open common bile duct exploration was done in 26 patients with both gallbladder and common bile duct （CBD）stones. After extraction of stones,an 8F J-stent （pigtailed）was placed to the duodenum over a guide wire. The CBD incision was primarily closed. Results： The stent was dislodged and discharged with stool at the 14th （10-18）postoperative day on average. 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. Conclusion： Placement of a self-release biliary 8F J-stent in CBD and into the duodenum during com-mon bile duct exploration is safe and efficacious. It can expand the indication of primary closure of CBD incision, and reduce the complications related to T-tubes.