腹腔镜联合电子胆道镜胆总管切开取石一期缝合32例分析

Analysis on 32 cases of primary suture in laparoscopy combined with electronic choledochoscopy choledocholithotomy

目的探讨腹腔镜联合电子胆道镜胆总管切开取石一期缝合治疗胆总管结石可行性及安全性。方法回顾性分析该院2010年8月至2014年8月行腹腔镜联合电子胆道镜治疗胆囊结石、胆总管结石,一期胆总管缝合的32例患者的临床资料。结果 32例均顺利行腹腔镜胆囊切除加胆总管切开胆道镜探查取石,胆总管一期缝合术,手术时间100~200 min,平均130 min,术中出血15~50 m L,平均30 m L,术后禁食1~3 d,术后肠功能恢复时间1~2 d,术后6~12 d出院,术后发生胆汁漏1例,胆汁小于80 m L/d,4 d后停止胆漏,该组32例患者获得随访,随访时间6~9个月,行磁共振胰胆管造影检查,无结石残留及胆道狭窄。结论腹腔镜胆总管一期缝合的安全性及可行性大大提高,具有创伤小,术后恢复快,住院时间短等优点,值得推广。

Objective To investigate the feasibility and safety of primary suture in laparoscope combined with electronic choledochoscope choledocholithotomy for treating choledocholithiasis. Methods The clinical data of 32 patients with cholecystolithiasis or choledocholithiasis treated by laparoscope combined with electronic choledochoscope choledocholithotomy with pri-mary suture in our hospital from August 2010 to August 2014 were retrospectively analyzed. Results 32 cases were successfully perfromed laparoscopic choledocholithotomy plus electronic choledochoscope with common bile duct primary suture. The opera-tion time was 100-200 min（mean 130min） with the introperative bleeding loss of 15-50 m L（average 30 m L）. The postoperative fasting time was 1-3 d,the time of gastrointestinal function recovery was 1-2 d and all cases were discharged from the hospital on6-12 d after operation. 1 case of bile leakage occurred,bile was less than 80 m L/d, the bile leakage stopped after 4 d. All the 32 cases were followed up with the follow-up time of 6-9 months. Magnetic resonance cholangiopancreatography showed no residual calculi and biliary stricture. Conclusion With the development of science and technology,especially the utilization of varieties of novalmedical apparatus/instrumentsand biological materials in clinical field,Thethe security and feasibility of laparoscopic choledocholithotomy Laparoscopic common bile duct primary suture can increase the safety and feasibility and has the advantages of little trauma,rapid postoperative recovery and short hospitalization duration,which is worth wide application.