腹腔镜胆总管切开取石后一期缝合术

Laparoscopic choledochotomy with primary closure

目的总结腹腔镜胆总管切开取石后一期缝合的可行性、手术适应证及临床价值。方法回顾性分析在我院接受了三孔法腹腔镜胆总管切开取石后一期缝合手术的62例胆总管结石患者的临床资料。结果62例手术均获成功，无中转开腹，3例并发胆漏，经腹腔引流3～5d后自愈。术后7～14d（平均8d）出院。62例均进行了随访，随访时间7～18个月（平均10个月），B超复查均无胆道狭窄及残余结石。结论在严格掌握手术适应证的前提下，腹腔镜胆总管切开取石一期缝合术是胆囊结石伴胆总管结石或单纯胆总管结石病例的首选治疗方法，值得临床推广。

Objective To summarize the feasibility ,surgical indications and clinical value of lap- aroscopic choledochotomy with primary closure. Methods The clinical data of 62 patients with choledo- cholithiasis who underwent laparoscopic choledochotomy with primary closure in our hospital from July 2010 to January 2012 were retrospectively analyzed. Results All 62 cases were operated success fully without conversion to open surgery. Three cases complicated with bile leakage were cured by abdominal drainage for 3 -5 days. The patients were discharged from hospital in 7 to 14 days（ mean 8 days）. All 62 cases were followed up for 7 to 18 months（ mean 10 months） ,the type -B ultrasonic examination showed no bile duct stenosis and residual stones. Conclusion If the operating indications are strictly mastered, it＇ s the first-choice treatment for gallbladder stones associated with common bile duct stones or simple common bile duct lithiasis cases by the primary suture after laparoscopic choledochotomy, worthy of being widely applied in clinic.