腹腔镜下胆总管探查一期缝合术并胆管内双J管内引流术的临床研究

The clinical application of common bile duct exploration,primary suture and biliary stent drainage with double J tube by laparoscope

目的探讨腹腔镜下胆总管探查取石、一期缝合并胆管内双J管内引流术的可行性和临床疗效。方法回顾性分析该院2008年9月～2011年7月收治的19例胆总管直径大于8mm的胆总管结石患者施行腹腔镜下胆囊切除、胆总管切开、胆道镜取石、胆管内双J管内引流术,总结该术式的适应证、操作技术及临床疗效,并将之与其他术式进行比较分析。结果 19例患者中18例手术获成功,1例中转开腹,术中取尽结石,术后未发现胆漏、胆管狭窄或残余结石。胆管内双J管17例于术后5～7d在胃镜下拔出,2例在术后1周内随大便自行排出。结论对于胆总管直径大于0.8cm,胆囊结石合并胆总管结石的病例,腹腔镜下胆总管切开探查取石、胆总管一期缝合、双J管内引流术是可行的,能缩短住院时间,降低医疗费用。

[Objective] To explore the feasibility and clinical effectiveness of common bile duct exploration,primary suture of common bile duct and biliary stent drainage with double J tube by laparoscope.[Methods] From Sep.2008 to Jun.2011,19 patients of common duct stones whose common bile duct diameter greater than 8 mm were enrolled in this study,and surgical procedures were compared to other.[Results] The procedure was accomplished in all 18 patients except 1 patient with no residual stones,no bile fistula and no biliary stricture.The double J tube was drawn out by gastroscope in 17 cases,and the remaining 2 stents were excreted by stool 1 week after operation.[Conclusions] It is feasible to perform laparoscopic common bile duct exploration and stone removal,biliary stent drainage with double J tube and primary suture of common bile duct for the patient of cholecystolithiasis combined choledocholithiasis,whose common bile duct diameter greater than 8 mm.Compared with other minimally invasive procedures,it is an effective method and can shorten hospital stay,decrease the medical cost.