既往胆道手术史患者腹腔镜胆总管探查取石术后胆总管一期缝合31例  

Primary closure of common bile duct following laparoscopic reexploration and choledocholithotomy in 31 patients with a history of biliary tract operation

作　　者：詹峰[1] 张云[1] 杨晓俊[2] 蒋超[1] 张淼[1] 张楷[1] 

机构地区：[1]江苏大学附属宜兴医院肝胆腹腔镜外科,214200 [2]南京医科大学第二附属医院普外科

出　　处：《中华普通外科杂志》2014年第10期756-759,共4页Chinese Journal of General Surgery

基　　金：江苏省卫生厅国际交流支撑基金资助项目（国合2012-35）;江苏省六大人才高峰D类基金资助项目（2013-WSN-025）

摘　　要：目的 探讨既往胆道手术史后再次腹腔镜下胆总管探查并一期缝合可行性、安全性、适应证.方法 回顾性分析我院2010年1月至2014年1月收治31例既往胆道手术后复发性胆总管结石患者行再次腹腔镜下胆总管探查并Ⅰ期缝合术的临床及随访资料.结果 31例患者无中转开腹,无穿刺损伤、术后出血、死亡等并发症.手术时间（106±32） min;术中失血量（52±16） ml;术后胃肠道恢复时间（23 ±3）h;术后住院时间（5.5±1.5）d.术中十二指肠损伤1例,予腔镜下修补,恢复良好;术后胆漏2例,通过通畅引流保守治疗,恢复顺利.术后随访l -12个月（中位随访时间6个月）.所有患者术后经B超复查未有胆道狭窄、结石复发并发症发生,生活质量满意. 结论 具有丰富腔镜手术经验的胆道外科医师实施再次腹腔镜下胆总管探查并Ⅰ期缝合术,技术上安全、可行,短期预后良好.Objective To investigate the feasibility and safety of primary closure of common bile duct following laparoscopic common bile duct reexploration and choledocholithotomy for recurrent or residual choledocholithiasis in patients with prior biliary surgery.Methods We retrospectively studied the clinical data of 31 patients who were diagnosed recurrent or residual common bile duct （CBD） stones after prior bile duct surgery.All of 31 patients had undergone primary closure following laparoscopic common bile duct reexploration between Jan 2010 and Jan 2014.Results In all the 31 patients,there was no conversion to open surgery.There were no complications due to port placement,postoperative bleeding and mortality.The operation time was （106 ±32） min; the volume of intraoperative blood loss was （52 ± 16） ml; the time of postoperative gastrointestinal function recovery and postoperative hospital stay were （23 ± 3） h,（5.5 ± 1.5） d respectively.Duodenal injury was found and repaired intraoperatively laparoscopically in one patient.Bile leakage occurred in 2 cases recovered by conservative therapy.No postoperative stricture of bile duct,recurrent or residual stones were observed during a period of 1 month to 1 year （mean follow-up 6 months）.Conclusions Primary closure following laparoscopic common bile duct reexploration for patients with a past history of biliary tract operation is safe,feasible,and effective procedure in hands of experienced laparoscopic surgeons.

关 键 词：胆总管结石 再手术 腹腔镜 Ⅰ期缝合 

分 类 号：R657.4[医药卫生—外科学]