腹腔镜联合胆道镜胆总管切开取石一期缝合的临床研究

Clinical Study of the Laparoscopic Choledochotomy Suture

目的:探讨腹腔镜联合胆道镜行胆总管切开探查取石一期缝合的安全性与有效性。方法:回顾性总结分析周口市中医院普外科2009年1月-2012年1月间,经腹腔镜联合胆道镜行胆囊切除、胆总管切开取石一期缝合术,治疗胆囊结石合并胆总管结石57例患者的临床资料。结果:腹腔镜下联合胆道镜胆总管切开探查取石一期缝合成功52例,2例高龄患者术后因低蛋白血症出现胆漏,经抗感染、营养支持治疗10d后治愈,治愈成功率91.2%。5例患者因胆总管解剖变异、扭曲、纤细直径<7mm,结石>15mm嵌顿取出困难,胆道出血、胆总管末端炎性水肿等原因而中转开腹并置入T管。全组手术时间90～160min,平均(110±30)min。住院时间6～15d,平均(10±3.3)d。1～3年随访51例,失访6例,随访率89.4%。随访的51例患者中,无胆总管狭窄及结石残留的发生。结论:腹腔镜联合胆道镜行胆总管切开探查取石一期缝合安全有效。

Objective： To study the effects of laparoscope combined with choledochoscope in common bile duct exploration and stone of the safety and effectiveness of suture.Method： A retrospective analysis from 2009 January to 2012 Department of general surgery in Zhoukou Hospital of Traditional Chinese Medicine in January after the laparoscopic cholecystectomy, choledocholithotomy and primary suture, clinical data of the treatment of cholecystolithiasis and choledocholithiasis in 57 patients.Result： All patients who received laparoscopy combined with choledochoscopy in the exploration of common bile duct stone suture was successful in 52 cases, 2 elderly patients with hypoproteinemia bile leakage, the anti-inflammatory, nutritional support for patients with 10 d after cure, the cure rate Qf success was 91.2%.5 patients with common bile duct anatomic variation, twisted, slender diameter 〈7 mm, Stone 〉 15 mm inlaid the removal difficulties, at the end of common bile duct biliary tract hemorrhage, inflammatory edema and other reasons and laparotomy and put into T tube.Operation time was 90-160 min, average （ 110 ± 30 ） rain. The average hospitalization time was 6-15 d, average （10 ±3.3 ）d.l^-3 years follow-up of 51 cases, 6 cases lost follow-up, follow-up rate was 89.4%. 51 cases with follow-up, no residual bile duct stricture and stone.Conclusion： The laparoscopic common bile duct exploration stone is a safe and effective suture.