腹腔镜联合胆道镜胆总管探查取石一期缝合术

The Clinical Value of Primary Suture in Laparoscopic Common Bile Duct Exploration under Laparoscope Combined with Choledochoscope

目的探讨腹腔镜联合胆道镜胆总管探查取石一期缝合术的价值。方法 2010年1月～2012年12月对21例胆囊结石合并胆总管结石行腹腔镜联合胆道镜胆总管探查取石一期缝合术。术中暂不切除胆囊,先显露胆总管,切开取石、纤维胆道镜探查、一期缝合,最后切除胆囊。结果 21例手术均获成功,无一例中转开腹,手术时间80～120 min,平均100 min;术中出血量3～20 ml,平均10 ml。术后住院时间7～9 d,平均8 d。术后胆漏1例,保守治愈。21例随访1～34个月,平均21个月,无结石复发和胆系症状。结论腹腔镜联合胆道镜胆总管探查取石一期缝合术具有创伤小、康复快等优点,是安全可行的。

Objective To discuss the clinical value of primary suture of common bile duct following laparoscopic common bile duct exploration（LCBDE） combined with eholedochoscope. Methods The clinical data of 21 patients with gallstone complicated with common bile duct stone who underwent the surgery from January 2010 to December 2012 were retrospectively analyzed. During the operation, the common bile duct was exposed before the removal of the gallbladder. The common bile duct was cut and the calculi were removed. After choledoehofiberscopic exploration and primary suture, gall bladder was removed. Results All the operations were performed successfully without conversion to open surgery. The operation time was 80 - 120 min （mean：100 min） ; the blood loss was 3-20 ml（ mean：10 ml） and the postoperative hospital stay was 7-9 d（ mean：8 d）. Bile leakage occurred in 1 case and was cured with conservative treatment. During the follow-up of 1-34 months （mean ：21 months） in 21 cases, no recurrence of calculi or biliary tract symptoms was observed. Conclusion Primary suture following LCBDE is feasible and safe, with the advantages of minimal invasion and rapid recovery.