三镜联合胆总管探查一期缝合临床分析

Clinical analysis of primary closure suture of common bile duct exploration combined with three kinds of endoscopies

目的 总结腹腔镜、胆道镜和十二指肠镜三镜联合治疗胆囊结石合并胆总管结石并一期缝合的方法及临床意义。方法 对该院2012年5月-2014年1月期间对87例胆囊结石合并胆总管结石患者实施了腹腔镜、胆道镜和十二指肠镜三镜联合鼻胆管引流＋胆囊切除＋胆总管探查一期缝合术,对其进行回顾性分析。结果 该组87例患者中成功82例,失败5例,无胆漏发生,术后3～6 d拔除鼻胆管,住院7～9 d。结论 三镜联合胆总管探查并一期缝合术既保持了十二指肠乳头Oddi括约肌的完整性及正常生理功能,又免除了长时间T型管引流的并发症,符合现代外科的损伤控制和快速康复理念。

【Objective】To explore the method of the treatment of cholecystolithiasis combined with choledocholithiasis under laparoscopy combined with choledochoscope and duodenoscope and analyze its clinical value.【Methods】Eighty-seven patients suffering from cholecystolithiasis combined with choledocholithiasis were treated with endoscopic nasobiliary drainage, laparoscopic cholecystectomy and primary suture of common bile duct after exploration co-operated by three kinds of endoscopies from May 2012 to January 2014 in our hospital and all the date were reviewed and analyzed. 【Results】82 cases succeeded while 5 cases failed in the group and no bile leakage occurred. The nasobiliary drainage duct was taken off 3 ~6 d after surgery, and the length of day was from 7 to 9days. 【Conclusion】The exploration and primary suture of common bile duct by 3 kinds of endoscopies not only keeps the integrity and normal physiological function of duodenal papilla Oddi sphincter, but also avoids complication of long-time T-tube drainage, which realizes modern surgical idea for damage control and rapid recovery.