56例腹腔镜胆总管切开取石术不放置T管引流的临床经验

Clinical experience of laparoscopic commom bile duct exploration with primary closure for treating choledocholithiasis

目的探讨腹腔镜、胆道镜微创手术治疗胆总管结石的疗效。方法选取2011年5月份至2012年10月份56例施行微创手术治疗胆总管结石的病例。既往均无胆总管结石手术史,无胆道狭窄畸形,排除胆管及周围恶性肿瘤病变;无肝内胆管结石,肝外胆管无残留结石;胆总管壁增厚扩张范围在1-2 cm,无明显急性炎性改变;术中胆总管十二指肠开口通畅。结果 56例患者均顺利完成手术,3例术后出现胆瘘,2例出现肺部感染,2例出现尿潴留。所有病例均顺利出院,无出现切口感染,无围手术期死亡。结论腹腔镜联合胆道镜治疗胆总管结石,行胆总管一期缝合,取石疗效确切,创伤小,无需留置T管,患者术后恢复快,住院周期短。

Objective To investigate the effect of laparoscopic choledocholithotomy with primary suture for common bile duct stones. Methods From 2011 May to 2012 October, 56 patients underwent laparoscopic common bile duct exploration and primary suture（without T-tube drainage） for treating choledocholithiasis. Of 56 cases, there were no personal history of common bile duct calculi operation,no stenosis or malformation of bile duct, no malignant tumor in and around bile duct, no intrahepatic calculus. The bile duct wall thickening and expansion ranged from 1 cm to 2 cm, and no obvious acute inflammatory reaction. Common bile duct twelve duodenal opening were unobstructed in operation.Results Fifty-six patients were successfully completed the operation. Five cases had complications,postoperative biliary fistula occurred in 3 cases, pulmonary infection in 2 case and urinary retention in2 cases, and all cured by conservative treatment, no wound infection, no peri-operation period death.Conclusion Laparoscopy common bile duct exploration and primary closure has good clinical effect for treatment of bile duct stones. The patients would get well soon without T-tube drainade and have small trauma, shorter hospitalization period.