腹腔镜胆总管探查T管引流术治疗急性重症胆管炎

Laparoscopic common bile duct exploration with T-tube drainage for the therapy of acute cholangitis of severe type

目的探讨腹腔镜胆总管探查T管引流术(laparoscopic common bile duct exploration with T tube drainge,LCTD)治疗急性重症胆管炎(acute cholangititis of severe type,ACST)的可行性和安全性,探讨LCTD治疗ACST时的手术适应证、手术时机的选择、手术要点和注意事项。方法回顾分析2009年1月至2017年10月中航工业西安医院肝胆外科采用LCTD治疗的27例ACST病人临床资料。结果27例ACST病人均顺利完成LCTD手术,无中转开腹。术后发生胆漏1例,肺梗死1例,胆总管结石复发并再次发生ACST 1例,二次行LCTD而治愈。结论ACST是急危重症病人,需要早期手术干预,只要病例选择适当,手术时机选择合理,LCTD应用于ACST是安全可行的,并且具有创伤小、恢复快的优点。

Objective To investigate the feasibility and safety of laparoscopic common bile duct exploration with T tube drainge(LCTD)in the treatment of acute cholangitis of severe type(ACST),and to explore the surgical indications,timing,key points and precautions of LCTD in the treatment of ACST.Methods The clinical data of 27 patients with ACST treated with LCTD in the Department of Hepatobiliary Surgery,Xi'an Hospital of AVIC Industry from January 2009 to October 2017 were analyzed retrospectively.Results 27 cases of ACST patients were successfully completed LCTD surgery,no conversion to laparotomy.Postoperative bile leakage occurred in 1 case,pulmonary infarction in 1 case,recurrence of choledocholithiasis and recurrence of ACST in 1 case,and the second LCTD was performed and cured.Conclusion ACST was a kind of acute severe disease,which need early surgical intervention.As long as appropriate cases were selected and surgical timing was reasonable,it was feasible and safe for employ LCTD for the therapy of ACST.Besides,LCTD has the advantage of less trauma and fast recovery.