腹腔镜胆总管支架术处理晚期壶腹周围癌胆总管下端梗阻

Treatment of Terminal Common Bile Duct Obstruction in Metastatic Periampulla Carcinoma by Laparoscopic Common Bile Duct Stent in 13 Patients

目的 探讨腹腔镜胆总管支架术处理晚期壶腹周围癌胆总管下端梗阻的手术方法。方法 采用腹腔镜胆总管探查术结合斑马导丝、胆道扩张导管、塑料支架和自膨式金属支架施行腹腔镜胆总管支架术 ,胆道扩张导管及球囊扩张后放置塑料支架或自膨式金属支架 ,胆管切口 4 0或 5 0可吸收缝线即时缝合或同时放置T管引流。Winslow孔附近常规放置腹腔引流管观察渗漏情况。结果 1 3例怀疑转移病灶腹腔镜取活检 9例证实胰腺癌 ,1例梗阻处胆管内壁胆道镜取活检证实胆管癌 ,3例未证实。 1 3例中 1 0例手术获成功 (胆总管支架通畅、黄疸减轻或消退 ) ,1例因狭窄上端波及肝总管而中转开腹放置塑料支架同时T管引流 ,1例胆漏腹腔引流 4d后自愈 ,1例放置塑料支架同时T管引流术后 1 5d死于胆道感染诱发肝肾功能衰竭。结论 选择合适病例 ,采用腹腔镜胆总管支架术处理晚期壶腹周围癌胆总管下端梗阻这一术式有效且较安全。

Objective To discuss the methods of treating the terminal common bile duct obstruction in metastatic periampulla carcinoma by laparoscopic common bile duct stent.Methods 13 patients with the terminal common bile duct obstruction in metastatic periapulla carcinoma,who were treated with laparoscopic catheter dilatation and biliary stent,were studied.Primary duct incision closure or T tube drainage was selected according to the situation of intraoperative choledochoscopic exploration. Absorbable suture 4 0 or 5 0 was used for the closure of the bile duct incision,or T tube drainage was placed in the meantime.The drainage tube of the abdominal cavity was routinely set round Winslow's foramen.Results 10 out of 13 patients received successful treatment.Bile juice leak was found in one patient,open abdominal operatin was given to one patient,another patient died of functiond failure of the liver and kidneys 15 days after laparoscopic operation.Conclusion Laparoscopic common bile duct stent is a safe and effective treating method for some patients with terminal common bile duct obstruction in metastatic periampulla carcinoma.