腹腔镜下胆总管一期缝合在胆总管探查术中的应用

Application of laparoscopic primary suture of common bile duct in common bile duct exploration

目的探讨腹腔镜胆总管探查术后一期缝合的可行性和临床价值。方法选取2014年1月~2017年6月46例因肝外胆管结石行腹腔镜胆总管探查后一期缝合的病例作回顾性分析。观察同期48例腹腔镜下探查+T管引流。对比观察两组术中情况(手术时间、出血量、取石成功率)、术后情况(胃肠功能恢复时间、术后并发症)和住院时间等指标。所有病例不含肝内胆管结石,术中经胆道镜或胆道造影排除胆道残石及狭窄,腔镜下一期缝合后小网膜孔常规放置多孔引流管。结果腹腔镜下一期缝合术后7例腹腔引流液含胆汁,均未特殊处理。术后平均住院日8.5d。所有病例术后门诊随访,3个月内复查B超和CT,未发现胆道残石,亦无一例发现肝外胆管狭窄。结论对经过严格选择的肝外胆管结石病例,经术中精细操作和术中胆道镜检查排除残石及下端狭窄后,腹腔镜下一期缝合可作为另一种理想的术式选择。

Objective To explore the feasibility and clinical value of primary suture after laparoscopic common bile duct exploration. Methods From January 2014 to June 2017, 46 cases of primary suture after laparoscopic common bile duct exploration for extrahepatic bile duct stones were retrospectively analyzed.Meanwhile,48 cases of laparoscopic exploration and T tube drainage were observed.Intraoperative conditions(operation time,blood loss,success rate of lithotomy),postoperative conditions(recovery time of gastrointestinal function,postoperative complications) and hospital stay were compared and observed between the two groups.All cases did not contain intrahepatic bile duct stones.During the operation,cholangioscopy or cholangiography was used to exclude biliary residual stones and stenosis.After the endoscope was sutured,the small omentum hole was routinely placed with porous drainage tubes. Results After the laparoscopic primary suture,there were 7 cases of intraperitoneal drainage containing bile,which were not specially treated.The average postoperative hospital stay was 8.5 d.All patients were followed up in the outpatient department after surgery,and re-examined by B-ultrasound and CT within 3 months.No biliary residual stones were found,and no extrahepatic bile duct stenosis was found. Conclusion For strictly selected cases of extrahepatic bile duct stones,laparoscopic primary suture can be another ideal surgical option after intraoperative fine operation and residual stones and lower end stenosis excluded by intraoperative choledochoscopy.