腹腔镜胆总管探查Ⅰ期缝合术的临床研究

Clinical Study on Laparoscopic Common Bile Duct Exploration and Primary Suture

目的：总结腹腔镜胆总管探查Ⅰ期缝合术的疗效和安全性。方法：对我院2008年8月—2010年2月实施的19例腹腔镜胆总管探查Ⅰ期缝合患者的临床资料进行分析,并以12例腹腔镜胆囊切除术患者和16例开腹胆总管探查、T管引流术患者作为对照组。比较3组患者术后胆总管通过时间（the hepatic hilum to the duodenum through time,HDTT）及血清肿瘤坏死因子-α（tumor-necrosis-factor-alpha,TNF-α）水平的变化。结果：腹腔镜胆总管探查Ⅰ期缝合组平均手术时间（75±20）min,术中平均出血（25.7±4.5）mL;并发胆漏2例;平均住院时间（8.1±1.6）d。随访3个月~1年,未见胆道残余结石及胆管狭窄;与对照组相比,腹腔镜胆总管探查Ⅰ期缝合术组术后HDTT一过性升高后随之明显下降,TNF-α水平较术前有显著下降（P〈0.01）。结论：腹腔镜胆总管探查I期缝合术是安全、有效的治疗方法,术后胆漏发生率较低;术后患者血清TNF-α水平较低,提示对患者恢复有利。

Objective：To study the efficacy and safety of laparoscopic common bile duct exploration and primary suture.Methods： The date of 19 patients with laparoscopic common bile duct exploration and primary suture compared with 16 cases of open choledochotomy T tube drainage and 12 cases of laparoscopic cholecystectomy were analyzed.Results： All 19 cases were cured.Average operating time was（75±20） min and average blood loss was（25.7±4.5） ml.Complications of bile leakage（2 cases）.Mean operative hospital stay was（8.1±1.6） days.;Common bile duct through time got by hepatobiliary scintigraphy showed obviously difference in comparison with laparoscopic cholecystectomy group on 1 and 3 days after surgery（P0.01）,but showed no difference on the fiveth day（P0.05）.The date of tumor necrosis factor alpha（TNF-α） showed significantly difference in comparison with open choledochotomy T tube drainage group on the seventh day after surgery（P0.01）.Conclusions： Laparoscopie common bile duct exploration and primary suture is safe and effective;The common bile duct pressure does not increase obviously after surgery;The TNF-α in the serums are decreased and immune response of liver reduced obviously after surgery,so illness recoverd fastly.