腹腔镜经胆囊管汇入部微切开胆道探查术后胆漏的预防  

The prevention of bile leakage in laparoscopic common bile duct exploration through micro-incision approach at the cystic duct-CBD junction

作　　者：刘燕南[1] 陈剑[1] 贺修文[1] 韦军民[1] 

机构地区：[1]北京医院普通外科,100730

出　　处：《中华普通外科杂志》2016年第6期479-481,共3页Chinese Journal of General Surgery

摘　　要：目的探讨腹腔镜经胆囊管微切开胆总管探查术后胆漏的预防方法。方法回顾性分析2007年8月至2015年2月147例腹腔镜胆囊切除经胆囊管微切开取石术病例。以2012年11月优化胆道缝合技术之前微切开胆总管探查的患者57例为对照组：2012年11月以后的患者90例为研究组。比较两组手术时间（proceduretime，PT）、术后住院时间（postoperative hospitalization time，PHT）、术后胆漏发生率及随访情况。结果对照组术后胆漏发生率为5．3％，研究组术后胆漏发生率为1．1％。研究组PHT明显较对照组缩短（t=1．98，P=0．0007），术后胆漏发生率减少（X^2=139．5．P=0．04），差异有统计学意义。结论腹腔镜经胆囊管微切开胆总管探查术后胆漏的预防，包括严格把握微切开适应证、熟练掌握腹腔镜的基本技术及镜下缝合技术、术中精细的胆道镜操作、缝合胆管壁全层、仔细检测有无漏胆。对于胆总管多发结石难以一次取净，或合并存在胆道高压的病例，要经微切开处放置T管引流。Objective To investigate bile leakage prevention in laparoscopic common bile duct （CBD） eholedoehoscopic exploration through micro-incision approach at the cystic duct-CBD junction. Methods From August 2007 to February 2015, a total of 147 cases undergoing laparoscopic CBD eholedoehoscopie exploration through micro-incision approach at the cystic duct-CBD junction were included in this study. From August 2007 to November 2012, 57 patients were treated with laparoseopic CBD exploration （ control group）. From November 2012 to February 2015, 90 patients were with optimized suture method of CBD （study group）. The outcomes of patients in two groups were compared, including procedure time （ PT ）, postoperative hospitalization time （ PHT ）, and postoperative complications. Results In control group, the bile leakage rate was 5.3% , compared to 1.1% in study group. There were significant differences in postoperative hospitalization time（ t = 1.98, P = 0. 000 7 ） and bile leakage rate （X^2 = 139. 5, P =0. 04 ）between the two groups. Conclusions The prophylaxis measurements during operation are important to prevent bile leakage in laparoseopie CBD eholedochoseopie exploration through micro-incision approach, including strict indications for micro-incision operation, proper expertise for laparoscopic eholecysteetomy and laparoscopie suturing, eholedoehoscopic exploration, and suturing the whole layer of CBD wall, and carefully checking the suturing spot in case of bile leakage. T-tube placement is recommended while bile leakage is suspected.

关 键 词：胆总管结石 腹腔镜 胆漏 

分 类 号：R657.42[医药卫生—外科学]