眼镜蛇形自行脱落胆道支架在改良四孔法腹腔镜胆总管探查术中的应用体会

Application of cobra self-removal biliary stent in modified four-port laparoscopic common bile duct exploration

目的:探讨新式自行脱落胆道支架在改良四孔法腹腔镜胆总管探查手术中的应用价值及其临床效果。方法:应用聚氨酯导管制成眼镜蛇形自行脱落胆道支架,为70例胆总管结石患者行改良四孔法腹腔镜胆总管切开取石、导丝置入、支架置入及胆总管切口一期缝合术。结果:手术时间90～155min,平均(106±95)min;出血量20～110mL,平均(35±15)mL。术后第1天出现短暂胰淀粉酶增高18例(25.71%),无急性胰腺炎发生。术后发生胆漏1例(1.43%),经内镜下鼻胆管引流术痊愈。术后住院3～9d,平均(4.5±2.9)d。支架均经肠道排出体外,支架排出时间2～7d,平均(4.2±1.5)d。结论:腹腔镜胆总管探查术中应用眼镜蛇形自行脱落胆道支架可达到有效胆道减压的目的,从而扩大了胆总管切口一期缝合的适应证,改良四孔法使手术操作更加方便快捷。

Objective: To explore the application value and effect of a novel self-removal biliary stent in modified four-port laparoscopic common bile duct exploration. Methods: The self-removal biliary stent was made as a cobra shape with the polyurethane conduit.Laparoscopic choledocholithotomy,stent placement with a guide wire and primary suture of common bile duct were performed with modified four-port method. Results: The operative time was 90-15 min with an average of (106±95)min and operative blood loss was (35±15)mL (range,20-110 mL).Transient hyperamylasemia occurred in 18 cases (25.71%) on the first postoperative day without acute pancreatitis.Bile leakage occurred in one patient after operation and was cured after endoscopic nasobiliary drainage.The postoperative hospital stay was 3-9 d with the mean of (4.5±2.9)d.All of the stents were discharged within 2-7 d,the mean time was (4.2± 1.5)d . Conclusions: Laparoscopic common bile duct exploration with the cobra self-removal biliary stent can reach the aim of effective biliary decompression,therefore,indication of primary closure of the common bile duct can be expanded.The modified four-port method makes the procedure more convenient.