双镜联合胆总管探查胆道一期缝合术后胆漏的防治  

Prevention and treatment of bile leakage after laparoscopic common bile duct exploration and choledochoscopy followed by primary suturing of choledochal incision

作　　者：尹飞飞[1] 孙世波[1] 李志钰[1] 李强[1] 

机构地区：[1]哈尔滨医科大学附属第二医院胆道腹腔镜外科,哈尔滨150086

出　　处：《中华肝胆外科杂志》2015年第2期113-116,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的 探讨双镜联合胆总管探查胆道一期缝合术后胆漏的原因及防治.方法 回顾性分析我科2011年6月至2013年6月实施的采用腹腔镜联合胆道镜胆总管探查胆道一期缝合治疗胆总管结石的52例临床资料.结果 52例均成功完成手术,术后全部治愈出院.手术时间55～145 min,平均（101±26） min;术中出血量10 ～ 100 ml,平均（36 ±28） ml;术后第1天患者均可下床活动;术后胃肠功能恢复时间37～74 h,平均（49.8±12.5）h;总住院时间7～15 d,平均（10.8 ±2.5）d,术后平均住院时间（5.7±1.7）d;住院总费用平均（24 827±3 776）元.术中发现缝合处胆漏2例,给予结节缝合加固后未再出现.术后胆漏5例,经通畅引流、保守治疗5d后痊愈出院.随访1～2年均无结石复发,结石清除率达100％,所有病例均未发生胆管狭窄及其他并发症.结论 只要熟练掌握腹腔镜、胆道镜操作及缝合技术,严格把握手术适应证,双镜联合胆总管探查胆道一期缝合术是一种安全、有效、可行的治疗胆总管结石的术式,值得临床推广与应用.Objeetive To analyze the causes and to explore prevention and management of bile leakage after laparoscopic common bile duct exploration with choledochoscopy followed by primary suturing of choledochal incision.Methods The clinical data of 52 patients with bile leakage after laparoscopic common bile duct exploration choledochoscopy and primary suturing of choledochal incision carried out for choledocholithiasis between June 2011 to June 2013 were retrospectively studied.Results All the 52 patients successfully underwent the laparoscopic surgery and left hospital.The operation time was （101 ± 26） minutes （range 55～ 145 minutes）.The intraoperative blood loss was （36±28） ml （range 10～ 100 ml）.All the patients were ambulatory after the first postoperative day.The recovery time of postoperative gastrointestinal function was （49.8 ± 12.5） hours （range 37 ～ 74 h）.The total hospitalization time was （10.8 ± 2.5） days （range 7 ～ 15 days）.The average hospitalization days after surgery was （5.7 ± 1.7） days.The average hospitalization cost was （24 827 ± 3 776） yuan.There were two patients who developed intraoperative bile leakage which was treated with further suturing.Five patients developed postoperative bile leakage and they were cured after unobstructed drainage for 5 days through conservative treatment.After a follow-up of 1 ～ 2years,there was no recurrent lithiasis.The stone clearance rate was 100%.There was no bile duct stricture or other complications.Conclusion In expert hands and with proper selection of patients,laparoscopic common bile duct exploration,choledochoscopy and primary suturing of choledochal incision were safe,effective and feasible for choledocholithiasis.

关 键 词：胆总管结石 腹腔镜 胆道镜 一期缝合 胆漏 

分 类 号：R657.4[医药卫生—外科学]