老年人结石性胆总管梗阻腹腔镜胆道一期缝合自行脱落J型管置入治疗的体会

Clinical application of self-releasing J-tube in the laparoscopic biliary tract exploration with primary suture in treating common bile duct occlusion by stones in elderly patients

目的探讨腹腔镜下行胆道J型管支架放置术治疗老年人胆总管结石的应用价值。方法对14例老年胆总管结石患者(≥70岁)进行回顾性分析,手术行腹腔镜下胆总管切开胆道镜探查取石后,通过导丝将J型管的远端置入十二指肠,原位缝合胆总管切口。结果 14例患者均获得手术成功,手术时间(170.0±44.5)min,术后平均住院时间为(8.7±2.6)d。术后有2例患者出现血清淀粉酶及肝功能暂时性升高,均无并发胆瘘、胆管出血、肝内外胆管残余结石,内支架管无堵塞、提前脱管、导管退入胆管及导管滞留等现象。术后支架全部随粪便排出,排出的平均时间为术后(16.3±4.7)d,自动脱管前后患者无不适。术后随访1~24个月,复查超声均无胆总管结石复发及狭窄。结论老年人结石性胆总管梗阻腹腔镜胆道一期缝合自行脱落J型管置入治疗是有效的胆管引流方法,该法既安全有效又减少了术中放置T型管引流及引起奥狄氏括约肌功能障碍的相关并发症。

Objective To explore the application value of self-releasing J-tube in the laparoscopic biliary tract exploration with primary suture in treating common bile duct occlusion by stones in elderly patients. Methods Clinical data of 14 elderly patients （≥70 years） with common bile duct stones were retrospectively analyzed .After the laparoscopic choledocholithotomy and cholangioscopy stone removal , the distal end of the J-tube was inserted into the duodenum , and the common bile duct incision was sutured in situ. Results The surgical success was achieved in all of 14 patients, operation time was （170.0 ± 44.5） min, and hospitalization time after operation was （8.7 ±2.6） days.The serum amylase and liver function indicators were temporarily increased in 2 patients, and all patients had no concomitant complications such as bile fistula , bile duct bleeding and residual stones within the internal and external bile duct, and had no phenomenon such as internal stent occlusion , early stent dislodgement , or stent retraction into the bile duct and stent retention .All stent tubes were excreted with feces after operation , and the mean excretion time was （16.3 ±4.7） days after operation.The patients had no discomfort before and after self-releasing of J-tube.The patients were followed up for 1 to 24 months, and the ultrasound reexamination showed no recurrence of calculus and stenosis in the common bile duct . Conclusion The application of self-releasing J-tube in the laparoscopic biliary tract exploration with primary suture are safe and effective , and could also reduce the complications related to T-tube placement and sphincter of Oddi dysfunction .