腹腔镜胆总管探查术一期缝合胆总管的指征及临床应用

Indication and clinical application of primary suture of common bile duct in laparoscopic common bile duct exploration

目的:总结腹腔镜胆总管探查术一期缝合胆总管的指征及临床应用经验。方法:回顾分析1992年6月至2011年3月为1 054例患者行腹腔镜胆总管探查一期缝合术的临床资料。结果:975例(92.5%)成功完成手术。5例胆总管残石经内镜取出治愈,4例肝内胆管残石未予处理。37例胆漏经腹腔引流管、腹腔镜、内镜或开腹引流治愈。2例术后出血,再次行腹腔镜手术止血治愈。1例胰腺癌患者术后15d死亡。术后胆管造影发现2例胆总管一期缝合处胆管狭窄,未予处理。术后乳头狭窄致梗阻性黄疸12例,轻症胰腺炎13例,应激性溃疡出血3例,均经内镜或非手术治疗治愈。其他术后并发症经非手术综合治疗治愈。结论:只要病例选择合适,腹腔镜胆总管探查一期缝合胆总管是安全、可行、有效的。

Objective：To summarize the indication and clinical experiences on laparoscopic common bile duct exploration with primary suture.Methods：The clinical data of 1 054 patients who underwent the primary suture following laparoscopic common bile duct exploration from Jun.1992 to Mar.2011 was retrospectively analyzed.Results：This procedure was successful in 975（92.5%） out of 1 054 patients.Five patients had residual stones and were cured with endoscopic sphincterotomy.Four patients who had residual stones were not treated.Thirty-seven patients suffered from bile leakage and were cured through abdominal drainage,laparoscopy,endoscopy and open abdominal surgery.Two cases of postoperative hemorrhage were cured with laparoscopic surgery.One patient of pancreatic carcinoma died in 15 days after operation.Two patients had bile duct stenosis at primary closure site and were not treated.Twelve cases of obstructive jaundice due to stenosis of duodenal papilla,thirteen cases of slight pancreatitis,and three cases of hemorrhage due to stress ulcer were treated with endoscopic or conservative therapy.The other postoperative complications were treated with conservative therapy.Conclusions：If patients are suitable,laparoscopic common bile duct exploration with primary suture is a feasible,effective and safe method.