腹腔镜胆总管探查一期缝合术的临床研究

The clinical study of primary suture of common bile duct in laparoscopic common bile duct exploration

目的:探讨腹腔镜胆总管探查一期缝合术的可行性及临床应用价值。方法:2008年7月至2013年7月为137例患者行腹腔镜胆总管探查术,其中胆总管一期缝合67例(一期组),留置T管引流70例(T管组),对比两种术式的疗效。结果:一期组与T管组手术时间[(79±10)min vs.(92±12)min]、术后住院时间[(4.9±1.0)d vs.(7.1±1.4)d]、胆漏发生率(7 vs.1)差异有统计学意义(P<0.05)。两组术后无其他严重并发症发生及手术死亡病例。术后随访1年,B超、CT检查均未发现胆漏、胆管狭窄及结石复发。结论:腹腔镜胆总管探查术后选择性行胆总管一期缝合,避免了T管留置引起的一系列弊端,是安全、可行、有效的,值得推广应用。其主要风险为胆漏,但胆漏多为短期漏,通过引流可自愈。

Objective：To explore the feasibility and clinical application value of primary suture common bile duct （CBD） after laparoscopie common bile duct exploration （LCBDE）. Methods ：From Jul. 2008 to Jul. 2013,137 patients were performed LCBDE,the primary suture of the CBD after LCBDE （group primary suture） was successfully performed in 67 patients, in 70 cases the T tube was put into the CBD after LCBDE （ group T tube）. The clinical effects of the 2 groups were retrospectively analyzed and compared. Re- stilts ：The average time of the operation [ （79 ± 10 ） min vs. （92 ± 12 ） rain ] , the average of hospital stay after operation [ （4.9 ± 1.0 ） d vs. （7.1± 1.4） d], the bile leakage rate （7/67 vs. 1/70 ） were significantly different between the two groups （P 〈 0.05 ）. No other serious complications or operation-related death occurred after operation in the 2 groups. During the follow-up of 1 year, no bile leakage, bile duct stenosis or recurrence of calculi were found by B-ultrasound and CT. Conclusions：The selective primary suture of CBD after LCBDE avoids disadvantages of T-tube,is safe ,feasible and effective ,worthy of clinical expansion. The main risk lies in bile leakage, but which is mostly short-term leakage, self-healing by drainage.