腹腔镜胆总管探查一期缝合690例临床研究报告

Primary suture after laparoscopic common bile duct exploration:report of 690 cases

目的研究腹腔镜胆总管探查一期缝合胆管的可行性、安全性、适应证及保障一期缝合安全的相关手术方法。方法回顾性分析1992年6月～2007年12月我院开展腹腔镜胆总管探查一期缝合术690例的临床资料。结果 690例中,688例成功进行了腹腔镜胆总管探查一期缝合,成功率99.7%(688/690);胆管阴性探查47例(6.83%),手术时间平均131min,术中出血平均22.5 ml,术后住院平均7.8 d;术后明显胆漏36例(5.23%);死亡1例(0.14%),为"胰头癌伴急性梗阻性化脓性胆总管炎"的老年患者,死于多脏器功能衰竭。结论腹腔镜胆总管探查一期缝合术微创优势明显,疗效肯定,方法安全可行,在条件具备的医院,对于合适的病例,可以作为腹腔镜胆总管探查术后,关闭胆总管切口的首选方式。

Objective To research the feasibility,safety,indications of primary suture after laparoscopic common bile duct exploration（LCBDE）.Methods The clinical data of 690 patients undergoing primary suture after LCBDE in our hospital from June 1992 to December 2007 were retrospectively analyzed.They all received laparoscopic cholecystectomy.Among them,choledochotomy with exploration was conducted in 672 cases.After the removal of stones in common bile duct（CBD） by direct extraction or lithodialysis,the CBD was closed primarily.Other 16 cases did exploration through duct of gallbladder followed by primary suture as well.Results Among 690 cases,primary suture after LCBDE were successful in 688 cases,and the success rate was 99.7%（688/690）;47 cases（6.83%） had negative exploration of CBD.Average operative time was 131 min,mean intraoperative bleeding was 22.5 ml,and postoperative length of stay was 7.8 d on average.Distinct bile leakage was found in 36 cases（5.23%）.An elderly patient with carcinoma of head of pancreas incorporated with acute obstructive suppurative cholangitis was dead after the surgery due to multiple organ failure.Conclusion Primary suture after LCBDE is minimally invasive,effective,safe and feasible.It can be used as the first choice operative procedure for suitable patients in hospitals with qualified personnel and equipments.