经胆囊管胆道造影与外引流在腹腔镜胆总管切开一期缝合术中的应用  

Primary closure after laparoscopic choledochotomy with transcystic cholangiography and biliary drainage

作　　者：管辉球[1] 丁明金[1] 赵国栋[1] 

机构地区：[1]江苏省丹阳市人民医院南通大学附属丹阳医院普通外科,212300

出　　处：《中华肝胆外科杂志》2017年第1期24-27,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：镇江市卫生科技重点项目（SHW2015021）;镇江市社会发展科技计划项目（FZ2015073）

摘　　要：目的分析比较胆总管切开一期缝合与胆总管切开一期缝合经胆囊管置细导管胆道造影和胆道外引流的治疗效果。方法回顾性分析2013年6月至2016年3月我院46例腹腔镜胆总管切开一期缝合（A组）与51例腹腔镜胆总管切开一期缝合经胆囊管胆道造影和胆道外引流（B组）患者的临床资料。结果腹腔镜胆总管切开探查一期缝合（A组）术后胆漏发生率较高，两组差异有统计学意义（8．7％比0，P〈0．05）。胆总管切开一期缝合经胆囊管胆道造影和胆道外引流组患者所需手术时间略长[（125．3±28．3）min比（131．3±20．5）min]，差异无统计学意义（P〉0．05）。两组患者术后住院时间差异无统计学意义[（7．3±2．4）d比（7．8±1．9）d，P〉0．05]。患者随访3-29个月，平均8．4个月，B超检查无胆管残余结石，肝功能正常。结论胆道镜的应用使胆总管一期缝合成为可能，经胆囊管胆道造影和胆道外引流使胆总管一期缝合更安全、可靠。Objective To assess the clinical outcomes in patients who underwent laparoscopic primary closure of common bile duct （CBD）with or without transcystic cholangiography and transeystic biliary drainage. Methods From June 2013 to March 2016, we operated on 46 patients who underwent primary closure of common bile duct after laparoscopie choledoehotomy （ group A）. The results were compared with 51 patients who underwent primary closure of common bile duct after laparoseopie choledochotomy together with transeystic biliary drainage （group B） during the same study period. Results There was a significant difference in the incidence of postoperative bile leakage between the two groups. The risk in group A was sig- nificantly higher than group B （ 8.7 % vs 0% , P 〈 0.05 ）. The duration of operation in group A was significantly shorter than in group B [ （ 125.3 ± 28.3 ） min vs （ 131.3 ± 20.5 ） rain ]. There were no significant differences in the duration of hospital stay between the two groups [ （7.3 ± 2.4） days vs （7.8±1.9） days, P 〉 0.05] All patients were followed up （ range 3 months to 29 months, average 8.4 months）. B-ultrasound examination showed no residual bile duct stones and the liver functions were normal. Conclusions Laparoscopie primary closure of common bile duct was possible after choledochotomy. Transcystic cholangiography and transcystic biliary drainage after primary closure of common bile duct were safer and more reliable.

关 键 词：胆总管切开 腹腔镜 胆道外引流 细导管 一期缝合 

分 类 号：R657.4[医药卫生—外科学]