胆总管探查术后一期缝合的临床经验及适应证探讨  

Study on Indications and Clinical Experience of Primary Suture after Common Bile Duct Exploration

作　　者：倪平志[1] 刘隽[1] 汤可立[1] 程建华[1] 罗丹[1] 

机构地区：[1]贵州省人民医院肝胆胰外科,贵州贵阳550002

出　　处：《中国普外基础与临床杂志》2011年第3期320-323,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的总结胆总管探查术后一期缝合的经验,探讨其适应证以及评价其临床效果。方法回顾性分析2006年2月至2010年6月期间137例行胆总管一期缝合手术患者的临床资料。结果所有患者手术均成功,手术时间65-213 min（平均129 min）,出血量50-350 ml（平均148 ml）。124例（90.5%）患者术后均未发生并发症,术后1周内顺利出院;其余13例（9.5%）患者术后出现漏胆,其中10例（18.5%,10/54）为技术早期（2007年10月以前）开展病例,3例（3.6%,3/83）为开展后期病例,均未作特殊处理,于术后3周内好转出院。113例（82.5%）患者获得随访,经过2-54个月随访（中位随访时间14个月）,无一例患者出现胆管残石、胆总管结石复发和胆管狭窄。结论在严格掌握手术适应证和具备熟练的手术技巧前提下,胆总管探查术后一期缝合是安全、有效的。Objective To summarize the clinical experience on primary suture after common bile duct exploration and to investigate its clinical indications and curative effects.Methods The clinical data of 137 patients underwent primary closure of common bile duct between February 2006 and June 2010 were analyzed retrospectively.Results All operations were successful.The operative time ranged from 65-213 min（mean 129 min） and the blood loss ranged from 50-350 ml with an average of 148 ml.One hundred and twenty-four patients（90.5%） were discharged from hospital without complications within 7 d after operation.Postoperative bile leakage occurred in 13 patients（9.5%） consisted of 10 early stage cases（18.5%,10/54） and 3 later stage cases（3.6%,3/83）,which were discharged with improvement by conservative treatment within 3 weeks after operation.Totally 113 patients（82.5%） were followed up for 2-54 months with a median time of 14 months,no residual or retained stone and biliary duct stricture occurred.Conclusion Only with the strict indication and proficient surgical technology,primary suture after common bile duct exploration is a safe and effective way to choledocholithiasis.

关 键 词：胆总管探查 胆囊结石 一期缝合 漏胆 适应证 

分 类 号：R657.4[医药卫生—外科学]