腹腔镜胆总管一期缝合术中应用自行脱落单J管并发症的临床分析  

A clinical analysis of complication of laparoscopic common bile duct primary closure surgery with self- releasing single- J tube

作　　者：蔡邢峰[1] 卢潮德[1] 肖旭[1] 

机构地区：[1]江苏省南通市第三人民医院普外科,226006

出　　处：《中国医师进修杂志》2016年第2期144-147,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨腹腔镜胆总管一期缝合术中应用自行脱落单J管的相关并发症和预防措施。方法回顾性分析2009年1月至2014年11月35例胆总管结石择期手术患者的临床资料，采取腹腔镜下胆总管切开取石后，胆总管内放置自行脱落单J管，再行胆总管一期缝合。观察术后并发症。 结果35例均在腹腔镜下完成手术。手术时间（120 ± 15）min，术中出血量（50 ± 15）ml。术后第1天淀粉酶正常或轻度短暂性升高。无术后胆漏、出血及切口感染病例。术后2- 4 d恢复饮食。术后腹部摄片，单J管位置良好。术后2- 3周单J管自行从肠道排出，无肠梗阻。住院时间（9.3 ± 1.8）d。术后2个月发现1例结石残留同时合并胆总管缝合处狭窄，行开腹手术T管引流术治愈。结论在腹腔镜胆总管一期缝合术中，应用自行脱落单J管，可为手术提供安全保证，尽管存在一些并发症，但这种手术方式创伤小，恢复快，仍然值得进一步推广和应用。Objective To explore the protective measure and the complication of common bile duct primary closure surgery with self-releasing single-J tube. Methods laparoscopic The clinical data of 35 choledocholithiasis patients having underwent selective operation were retrospectively analyzed from January 2009 to November 2014. The operation was laparoscopic choledocholithotomy, a self-releasing single J-tube was placed in the common bile duct, and the common bile duct was primary closure. The postoperative complication was observed. Results All the patients were operated under laparoscope. The operative time was （120 ± 15） min, and the intraoperative bleeding was （50 ± 15） ml. The levels of diastase was normal or increased slightly 1 d after operation. There were no postoperative bile leakage, bleeding and incision infection. The diet was recovered 2 - 4 d after operation. Postoperative abdominal X-ray result showed that single-J tube position was good. Two - three weeks after operation, the single-J tube was discharged from the intestinal tract, without intestinal obstruction. The length of stay was （9.3 ± 1.8） d. Open operation with T tube drainage was performed in one case with the complication of stone residue and stenosis of common bile duct. Conclusions In laparoscopic common bile duct primary closure surgery, self-releasing single-J tube can provide security guarantees in patients with choledocholithiasis. Although there are some complications, it has less trauma and quicker recovery, and deserves further popularization and application.

关 键 词：腹腔镜 胆总管结石 手术后并发症 回顾性研究 单J管 

分 类 号：R657.4[医药卫生—外科学]