腹腔镜胆总管切开取石一期缝合术75例临床分析

Clinical experience of laparoscopic choledocholithotomy and primary suture:a report of 75 cases

目的：探讨腹腔镜胆总管切开取石一期缝合术治疗胆总管结石的临床疗效、手术适应证、缝合方式的选择及术后胆漏的发生原因。方法：回顾分析2011年7月至2013年1月为75例胆总管结石患者行腹腔镜联合胆道镜取石术并一期缝合的临床资料。结果：75例均成功完成腹腔镜胆总管切开取石一期缝合术。手术时间70—185min，平均（93±12．6）min；术中出血量15～45ml，平均（21±4．5）ml；术后住院3～12d，平均（5±1．8）d。术后19例发生胆漏，其中18例经禁食、抗感染、腹腔通畅引流等保守治疗后痊愈出院，1例术后第15天带管出院，第31天拔除引流管。结论：严格掌握手术适应证、术者具备良好的镜下缝合打结技术，行腹腔镜胆总管切开取石一期缝合术是安全、可靠的，可有效降低胆漏、胆管狭窄等并发症发生率。

Objective：To explore the clinical efficacy, operative indications, choice of suture approach, and the causes of postoperative bile leakage of laparoscopic choledocholithotomy and primary suture. Methods：The retrospective analysis was made on clinical data of 75 patients who suffered from choledocholithiasis and underwent laparoscopic and cboledochoscopic choledocholithotomy and pri- mary suture from Jul. 2011 to Jan. 2013. Results： All the 75 cases of ]aparoscopic choledocholithotomy and primary suture were suc- cessfully completed. The operative time was 70-185 min, the average was （93 ＋ 12.6 ） rain, average blood loss was （21 ＋ 4.5 ） ml （ range, 15-45 ml ）, postoperative hospital stay was 3-12 d with the mean of （ 5 ＋ 1.8 ） d. 19 patients suffered from bile leakage, of which 18 cases were cured after conservative treatment such as fasting, anti-infection, abdominal unobstructed drainage; 1 patient was dis- charged with a tube on the postoperative 15th day and drainage tube was removed on the 31 st day. Conclusions：On the premise of strict control of indications and preferable abilities of suture and knot, laparoscopic choledocholithotomy and primary suture is safe and reliable, can effectively reduce the complications incidence, such as bile leakage and bile duct stenosis.