腹腔镜胆总管探查一期缝合术并发症及治疗策略  

The complications and treatment strategies for laparoscopic common bile duct exploration and primary suture

作　　者：刘东斌[1] 刘家峰[1] 徐大华[1] 王悦华[1] 仝小刚[1] 郑亚民[1] 江华[1] 蔡伟[1] 张小丽[1] 王会元[1] 赵菁[1] 李非[1] 

机构地区：[1]首都医科大学普通外科学系首都医科大学宣武医院,北京100053

出　　处：《腹腔镜外科杂志》2015年第11期855-858,共4页Journal of Laparoscopic Surgery

摘　　要：目的：分析腹腔镜胆总管切开取石一期缝合术后常见并发症的原因,探讨预防与治疗并发症的策略。方法：回顾分析2009年12月至2014年10月为132例胆囊结石合并胆总管结石患者行腹腔镜胆总管切开取石一期缝合术的临床资料。结果：132例患者中,胆漏13例,占9.85%,其中12例经保守治疗治愈,再次腹腔镜手术1例。残余胆总管结石2例,发病率1.52%。胆总管结石再发1例,占0.76%。术后腹腔出血1例,占0.76%,保守治疗痊愈。随访4-58个月无术后胆道狭窄。结论：胆漏是腹腔镜胆总管切开取石一期缝合术最常见的并发症,严格把握手术指征,认真评价术前影像学,术中熟练的胆道镜操作,精准胆道缝合可减少并发症的发生。Objective： To analyze the reasons of complications after laparoscopic common bile duct exploration and primary suture（ LBEPS） to treat the patients with common bile duct stones,and to explore the strategies for prevention and treatment. Methods：One hundred and thirty-two patients with common bile duct stones and gallbladder stones treated by LBEPS from Dec. 2009 to Oct.2014,their clinical data were retrospectively analyzed. Results： One hundred and thirty-two patients completed the surgery. There were13 cases with bile leakage（ 9. 85%）. 12 patients with bile leakage were cured by conservative treatment,and one case was cured by laparoscopic exploration. There were two cases with residual choledocholithiasis（ 1. 52%） and one case with recurrent choledocholithiasis（ 0. 76%）. One case with postoperative abdominal bleeding（ 0. 76%） was performed conservative treatment. Patients were followed up for 4 months to 4 years 10 months,there was no case with postoperative biliary stricture. Conclusions： Bile leakage is the most common complication after LBEPS. Some details could reduce the postoperative complications of LBEPS,these include strict grasping surgical indication,seriously preoperative imaging evaluation,skillful choledochoscopic technology and precise suture of bile duct.

关 键 词：胆囊结石病 胆总管结石 胆总管一期缝合 腹腔镜检查 胆道镜检查 手术后并发症 

分 类 号：R657.4[医药卫生—外科学]