摘要
2009年4月～2011年6月行腹腔镜胆总管切开取石胆道一期缝合36例。采用四孔法,气腹压力12 mm Hg。解剖出十二指肠上段胆总管,锐性切开,长0.8～1.5 cm,上下两端各用4-0薇乔线缝合1针牵引。从剑突下trocar置入胆道镜行胆总管探查、取石,4-0薇乔线间断缝合胆总管前壁。36例均成功完成腹腔镜胆总管切开取石胆总管一期缝合,无中转开腹。手术时间43～96 min,(63±22)min。术中出血20～35 ml,(23±6)ml。术后胆漏2例,经腹腔引流8 d后自愈。术后7～10 d(平均7.7 d)出院。32例随访3～26个月,平均16.2月,未见结石残留及胆管狭窄。我们认为腹腔镜胆道一期缝合胆管安全可行,能避免置T管带来的弊端,但必须严格掌握手术适应证,遵循术中取净结石及胆总管通畅的原则。
Since April 2009 to June 2011, we performed laparoscopic common bile duct （CBD） exploration and stone extraction with primary closure on totally 36 patients. With four ports and pneumoperitoneum at 12 mm Hg, we separated the upper CBD （ duodenal segment） , and made a O. 8 - 1.5-cm incision with the two end of the incision sutured with 4-0 Vicryl thread （ one stitch） for drawing. Afterwards, a choledochoscope was placed through the trocar under the xiphoid for CBD exploration and stone extraction. The CBD was closed with the 4-0 Vicryl thread after the procedure was completed. Primary closure was achieved in all the cases without conversion to open surgery. The mean operation time was （63 ＋ 22） min （ ranged from 43 to 96 min）. The intraoperative blood loss ranged from 20 to 35 ml with a mean of （23 ＋ 6） ml. No residual stones were detected after the operation; two patients developed biliary leak but were then cured by abdominal cavity drainage. The patients were discharged from hospital in 7 to 10 days （mean 6 days） postoperation, 32 of them received a follow-up for 3 to 26 months （ mean, 16.2 months）, during which no residual stones or biliary stricture was revealed. We believe that laparoscopic CBD exploration and stone extraction with primary closure is feasible and safe without the disadvantages of T-tube drainage; however we must strictly control the indications of the procedure, and assure the stones are removed completely and the CBD is patent.
出处
《中国微创外科杂志》
CSCD
2012年第9期828-829,834,共3页
Chinese Journal of Minimally Invasive Surgery
关键词
腹腔镜
胆道探查
一期缝合
Laparoscopy
Common bile duct exploration
Primary closure
