同期两镜或同期三镜下胆总管探查一期缝合术2779例

Primary closure of bile duct incision with simultaneous two or three kinds of endoscopy in laparoscopic bile duct exploration: a report of 2 779 cases

目的探讨同期两镜(腹腔镜+胆管镜)或同期三镜(腹腔镜+胆管镜+十二指肠镜)下胆总管探查一期缝合术的临床应用。方法回顾性分析1992年6月至2018年6月期间,成都市第二人民医院运用同期两镜或同期三镜下胆总管探查一期缝合术对2779例患者进行治疗的经验及效果。结果一期缝合的2779例患者中有2566例(92.3%)腹腔镜手术获成功,中转开腹一期缝合术获成功16例(0.6%);术后胆汁漏117例(4.2%),术后残石31例(1.1%),1例胰腺癌术后15d死亡(0.1%),术后出现其他并发症48例(1.7%),总并发症发生率为7.1%(197/2779)。结论对本医院有限病例进行初步研究发现,只要选择合适的病例,同期两镜或同期三镜下胆总管探查一期缝合术是可行、有效和安全的。

Objective To explore the surgical technique and clinical effect of primary closure of bile duct incision with simultaneous two endoscopy(laparoscopy+choledochoscopy)or three endoscopy(laparoscopy+choledochoscopy+duodenoscopy)in laparoscopic bile duct exploration.Methods From Jun.1992 to Jun.2018,2 779 patients were received the primary closure of bile duct incision with simultaneous two or three endoscopy in laparoscopic bile duct exploration in Chengdu Second People's Hospital.Results The operation of choledochotomy was successful in 2 556 cases.Sixteen patients were converted to open laparotomy.After surgery,there were 117 cases of bile leakage,31 cases of residual stones,1 case of death of pancreatic cancer on the 15th day,and 48 cases of other complications.The total complication rate was 7.1%(197/2 779).Conclusion From preliminary results of limited cases in this study,if patients are suitable,the primary closure of bile duct incision with simultaneous two or three endoscopy in laparoscopic bile duct exploration is a feasible,safe and effective method.