腹腔镜胆总管探查即时缝合术983例报告  

Primary closure of bile duct incision in laparoscopic bile duct exploration:a report of 983 cases

作　　者：李波[1] 陈安平[1] 索运生[1] 刘安[1] 易斌[1] 王征夏[1] 肖宏[1] 陈先林[1] 龙飞伍[1] 孙科[1] 

机构地区：[1]成都市第二人民医院肝胆胰外科,610017

出　　处：《中华腔镜外科杂志（电子版）》2010年第5期26-30,共5页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的总结运用腹腔镜胆总管探查即时缝合术的治疗经验。方法从1992年6月至2010年4月,运用腹腔镜胆总管探查即时缝合术的手术方式,对983例患者进行治疗。结果 983例患者中有904例(91.9%)治疗获成功。5例胆总管残石经内镜取石治愈,4例肝内胆管残石未予处理。37例胆漏经腹腔引流管、腹腔镜、内镜或开腹引流治愈。2例术后术野出血,再次腹腔镜下手术止血治愈。1例胰腺癌术后15d死亡。术后胆管造影发现即时缝合区胆管狭窄2例,未予处理。术后乳头狭窄致梗阻性黄疸12例、术后轻症胰腺炎13例、应激性溃疡出血3例,均经内镜或非手术综合疗法治愈。术后发生的其他多种并发症均经非手术综合疗法治愈出院。结论只要选择合适的病例,腹腔镜胆总管探查即时缝合术是可行、有效和安全的。Objective To summarize the experience on laparoscopic choledochotomy with primary suture. Methods From June 1992 to April 2010 in the Second People,s Hospital of Chengdu, 983 patients were received the primary closure of duct incision in laparoscopic common bile duct exploration. Results It had obtained successful in 904 （ 91.9% ） out of 983 patients. Five patients had residual stones then cured with endoscopic sphincterotomy. Four patients had residual stones then no cured with endoscopy. Thirty-seven patients had bile leakage cured through patent drainage, laparoscopy, endoscopy and open abdominal operation. Two patients was hemorrhage in the operation position with laparoscopic therapy. One patient of pancreatic carcinoma died in postoperation 15 days. Two patients had bile duct stenosis of primary closure of duct incision. The remaining complications were treated with endoscopic and conservative therapy to include the obstructive jaundice of twelve cases, the slight pancreatitis of thirteen cases, the hemorrhagiculcer of three cases in postoperation. Conclusions If patients are suitable, laparoscopic choledochotomy with primary closure was a feasible, safe and effective method.

关 键 词：腹腔镜 胆总管探查术 即时缝合 

分 类 号：R657.4[医药卫生—外科学]