腹腔镜胆总管探查术242例临床分析

Clinical analysis of 242 cases of laparoscopic common bile duct exploration

目的为了探讨腹腔镜下胆总管探查术的临床应用效果。方法回顾性分析我院2007年6月~2016年6月242例腹腔镜下胆总管探查术的临床资料。术中行胆总管探查T管引流术170例,胆总管切开探查一期缝合42例,经胆囊管探查胆总管取石30例。结果本组242例患者中,手术时间70~260min,平均130min,术中失血30~460ml,平均150 ml。胆漏30例,28例经腹腔引流管引流4~7天治愈,2例形成腹腔局部积液经B超定位穿刺引流而治愈。肺部感染6例,胸腔积液4例,切口感染2例。20例术后行T管造影检查证实为胆管残余结石,经胆道镜1~4次取石后取净;2例患者胆道镜无法取出残余结石,经ERCP取出残余结石。术后第1d所有患者可下床活动,平均输液时间4~8d。结论腹腔镜下胆总管探查术是相对微创安全的手术,应根据患者具体情况采取个体化的术式。

ObjectiveTo investigate the clinical effect of laparoscopic common bile duct exploration surgery. Methods The clinical data of 242 cases of laparoscopic common bile duct exploration in our hospital in from June 2007 to June 2016 were retrospective analyzed. 170 cases of common bile duct exploration and T-tube drainages were performed, 42 cases were performed by application of primary suture of common bile duct in laparoscopic bile duct exploration,30 cases of common bile duct exploration were performed through cystic duct exploration. Results The operative time was 70 - 260min during 242 cases of patients, an average time is 130min, intraoperative blood loss is 30 ~ 460ml. mean is 150 ml. 30 cases developed bile leakage and 28 cases of them were performed by peritoneal drainage for 4 to 7 days to cure, two cases of localized peritoneal fluids were formed and were performed by B-ultrasound guided needle drainage and cure. Pulmonary infection occurred in 6 cases, 4 cases of them developed pleural effusion, 2 cases developed wound infection. 20 cases of them were diagnosed with bile duct residual stones through postoperative T tube angiography, the stones were removed through cholangioscopy after 1 to 4 times; 2 residual stones were removed by ERCP. 1 d after surgery all patients could get out of bed, the mean infusion time was 4 ~ 8d. Conclusion Laparoscopic common bile duct exploration is a relatively safe minimally invasive surgery, should be taken according to individual surgical patients with specific conditions.