腹腔镜联合胆道镜探查取石一期缝合治疗肝外胆管结石  

Primary closure after laparoscopic common bile duct exploration with fibrocholdochoscopy for the management of extrahepatic bile duct stones

作　　者：姚金科[1] 曾宪成[1] 黄延年[1] 张晓[1] 徐鋆耀[2] 

机构地区：[1]广州市增城区人民医院(中山大学孙逸仙纪念医院增城院区)普通外科,511300 [2]中山大学孙逸仙纪念医院肝胆外科

出　　处：《中华实验外科杂志》2015年第9期2240-2242,共3页Chinese Journal of Experimental Surgery

摘　　要：目的 探讨运用腹腔镜联合纤维胆道镜对肝外胆管结石进行切开探查取石及一期缝合的治疗方法.方法 分析选择性运用腹腔镜联合胆道镜探查取石一期缝合治疗肝外胆管结石113例（腹腔镜组）及开腹胆总管切开探查取石一期缝合治疗肝外胆管结石141例（开腹组）,两组患者的手术经过及预后情况.结果 两组所有患者手术均获成功,腹腔镜组无中转开腹.腹腔镜组术后发生胆瘘3例（2.7％）,开腹组术后发生胆瘘4例（2.8％）,两组胆瘘发生率比较差异无统计学意义（P＞0.05）.两组患者中首次肛门排气时间腹腔镜组为（2.00±0.11）d,开腹组为（2.66±0.09）d,差异有统计学意义（P＜0.05）;腹腔镜组术后住院时间为（7.39±0.14）d,开腹组为（8.98±0.33）d,差异有统计学意义（P＜0.05）.结论 严格选择性运用腹腔镜联合胆道镜探查取石一期缝合安全可行.Objective To summarize the experiences of primary closure after laparoscopic common bile duct exploration （LCBDE）.Methods 113 patients in LCBDE group were studied,who underwent LCBDE combined with choledochoscopy for extrahepatic bile duct stones.After LCBDE,the choledochotomy was closed by primary closure.141 patients in open surgery group were studied,who underwent open common bile duct exploration （CBDE） combined with choledochoscopy for extrahepatic bile duct stones.After CBDE,the choledochotomy was closed by primary closure.Results There was no mortality and bile duct injury.In LCBDE group,none of them was converted to open surgery and experienced postoperative complications,and residual stone.Postoperative bile leak occurred in 3 patients （2.7％） in group LCBDE and 4 patients （2.8％） in open surgery group,respectively （P ＞ 0.05）.The time of the first nostonerative aerofluxus shorter in group L [（2.00 ± 0.11） d] than in group O [（2.66 ± 0.09） d,P ＜ 0.05].The hospital stay was significantly shorter in group L [（7.39 ±0.14） d] than in group O [（8.98 ±0.33） d,P ＜ 0.05].Conclusion Primary closure after laparoscopic common bile duct exploration combined with choledochoscopy is safe and effective for the management of extrahepatic bile duct stones,and can be performed selectively in qualified hospitals.

关 键 词：腹腔镜 纤维胆道镜 肝外胆管结石 一期缝合 

分 类 号：R657.42[医药卫生—外科学]