自行脱落双肩猪尾巴内支架管在胆总管探查术中的应用  

Primary closure of choledochotomy with a self-releasing pigtail biliary stent after common bile duct exploration

作　　者：曹玉军[1] 孙象军[1] 何强[1] 秦军[1] 杜成江[1] 牛纪祥[1] 江红星[1] 韩伟[1] 

机构地区：[1]山东省临沂市人民医院肝胆外科,276003

出　　处：《中华肝胆外科杂志》2014年第10期723-725,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的 探讨腹腔镜与开腹胆总管切开探查术中选择性放置双肩猪尾巴内支架管（以下简称支架管）及胆总管切口原位缝合的方法、效果及可行性.方法 48例胆总管结石患者分别采用腹腔镜（n=12）或开腹手术（n=36）.完成胆总管切开探查取石后,通过导丝将支架管的远端置入十二指肠,原位缝合胆总管切口.结果 支架管均于术后随粪便自行排出,平均排出时间为14（10 ～18）d,其中7例患者术后血清淀粉酶出现短暂性轻微升高.无胆漏、提前脱管、堵管或支架管滞留胆管等并发症.结论 胆总管探查术中选择性经导丝向胆总管和十二指肠内放置自行脱落的支架管并原位缝合胆总管切口是有效的胆管引流方法.该法既方便又安全,可减少放置“T”型管引流的相关并发症.Objective To study the efficacy of primary closure of choledochotomy with placement of a modified biliary stent after laparoscopic and conventional open common bile duct exploration.Methods 48 patients underwent laparoscopic （n =12） or open common bile duct exploration （n =36） for gallbladder and common bile duct （CBD） stones.After extraction of all CBD stones,the distal end of an 8F stent （pigtail） was placed into the duodenum over a guide wire.The CBD incision was closed primarily.Results The stent was dislodged and discharged with stool on the 14 （10 ～ 18） th postoperative day on average.Seven patients developed transient hyperamylasemia in the immediate postoperative period.No patients had the complications of bile leak,stent occlusion,early stent dislodgement,or stent retraction into the CBD.Conclusions Placement of a self-release biliary 8F stent in CBD and into the duodenum during common bile duct exploration is a safe and efficacious method.It can reduce the complications related to T-tubes.

关 键 词：胆总管结石 胆总管探查 胆总管切口原位缝合 胆管内支架 

分 类 号：R657.4[医药卫生—外科学]