腹腔镜胆总管探查胆总管一期缝合54例体会

Laparoscopic common bile duct exploration with primary closure for management of choledocholithiasis:experience of 54 cases

目的探讨胆道探查术后一期缝合胆总管的可行性及手术指征和手术方法。方法 2010年12月-2015年6月,采用联合腹腔镜及胆道镜实施胆总管切开取石、胆总管一期缝合术54例。结果根据术前病历选择标准实施的54例手术均获得成功,手术时间68-137 min,平均92 min。术中出血20-150 m L,平均82 m L;术后住院5-14天,平均6.8天。3例术后胆漏,经腹腔引流1周至12天后痊愈,其余51例术后48-72 h拔出腹腔引流管。术后随访1个月至3年,复查彩超均未发现结石残留及胆道狭窄。结论腹腔镜胆总管探查胆总管一期缝合术治疗胆总管结石具有创伤小、住院时间短及并发症少的优势,但应严格把握适应证及掌握操作技巧。

Objective To investigate the feasibility and introduce the experience of primary suture of common bile duct after bile duct exploration. Methods Fifty-four cases with choledocholithiasis were presented and underwent laparoscopic common bile duct exploration with primary closure from December 2010 to June 2015. The clinical effect and our experience were discussed and analyzed.Results The operation time ranged from 68 min to 137 min（average 92 min）. Operative bleeding was from 20 m L to 150 m L（average 82 m L）. Postoperative hospital stay was 5-14 days（average 6.8 days）.Postoperative bile leakage occurred in three cases and was healed by abdominal drainage for 7 days to 12 days. All the patients were followed for one months to 3 years,and the residual stones and biliary stricture were not found. Conclusions The management of laparoscopic common bile duct exploration in one stage suture showed less trauma,short hospital stay and less complications. Suggestion is the grasp of the indications and surgical skills before operation.