1273例腹腔镜胆管探查临床分析  

Laparoscopic common bile duct exploration:A clinic analysis of 1273 case

作　　者：田刚[1] 陈安平[1] 尹思能[1] 龙飞伍[1] 肖宏[1] 陈先林[1] 孙科[1] 王征夏[1] 王一平[1] 

机构地区：[1]四川省成都市第二人民医院肝胆胰外科,四川成都610017

出　　处：《中国内镜杂志》2011年第6期615-618,621,共5页China Journal of Endoscopy

摘　　要：目的探讨腹腔镜胆管探查(LCBDE)的手术适应证、术前诊断、术式选择、并发症的防治及其临床应用的安全性和价值。方法结合文献,回顾性分析1992年～2007年该院1273例腹腔镜胆管探查的临床资料。结果 1273例患者中有肝外胆管结石1148例,占90.18%(1148/1273),程度不同的急性胆管炎188例,占14.76%(188/1273),60岁以上老年患者549例,占43.12%(549/1273);共有1260例成功施行了LCBDE,因各种原因放弃LCBDE或改为开腹手术13例,手术成功率98.97%(1260/1273)。在成功实施LCBDE的1260例中,安放T管564例,一期缝合690例,腹腔镜下胆肠内引流术6例。术后漏胆42例,除重置T管5例外,余经持续引流保守治愈。没有术中死亡,术后1个月内死亡7例,均为老年患者。手术死亡率0.54%(7/1273)。胆管阴性探查85例,阴性探查率6.75%(85/1260)。术中平均失血30.7mL,平均手术时间147min,术后平均住院时间9.1d。治愈好转率99.44%(1253/1260)。结论 LCBDE是一种有效、安全、适应证广泛的胆管结石的微创治疗方法。若能把控好手术相关细节,可以作为胆管结石,尤其是肝外胆管结石的首选术式。[Objective] To investigate diagnosis,technique,operative indication and complication,and reliability of laparoscopic common bile duct exploration（LCBDE）.[Method] Retrospective analysis of clinical data of 1273 samples were performed of laparoscopic exploration of common bile duct in our institution from 1992 to 2007.[Result] Extrahepatic bile duct stone was 1148 cases,90.18%（1148/1273）.Acute cholangitis was 188 cases,14.67%（188/1273）.Over 60 year＇s patient was 549 cases,43.12%（549/1273）.1260 cases were successful performed laparoscopic common bile duct exploration.13 cases were diverted open operation or given up to continue executing laparoscopic common bile duct exploration for different reason.Operative achievement ratio was 98.97%（1260/1273）.In all 1260 cases,564 cases were implanted tee-pipe,690 cases were performed primary bile duct suture,and 6 cases were executed laparoscopic biliary-intestinal tract internal drainage.Bile leakage was detected in 42 cases postoperative,in which 5 cases were implanted tee-pipe again because of exodus of tee-pipe or severe peritonitis,the others were cured by perseverative drainage and conservative therapy.No one patient died during operation and 7 senile patients died in one month after operation.Mortality was 0.54%（7/1273）.Negative morbid change was detected in 85 cases,and negative exploration rate was 6.75%（85/1260）.Mean of hemorrhage was 30.7ml,and average of operative time was 147 minute,and average length of stay was 9.1 days after operation.Recovery rate was 99.44%（1253/1260）.[Conclusion] Laparoscopic common bile duct exploration was a safety and effective therapeutic method,and which can be preferred method to treat bile duct stone,especially extrahepatic bile duct stone.

关 键 词：腹腔镜 胆总管探查术 胆管结石 胆道镜 一期缝合 

分 类 号：R657.4[医药卫生—外科学]