腹腔镜胆总管一期缝合经胆囊管置管胆道外引流的作用  

Effect of External Biliary Drainage via Cystic Duct in Laparoscopic Choledochotomy with Primary Closure

作　　者：丁明金[1] 管辉球[1] 赵国栋[1] 

机构地区：[1]江苏省丹阳市人民医院普通外科,丹阳212300

出　　处：《中国微创外科杂志》2017年第6期512-514,523,共4页Chinese Journal of Minimally Invasive 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：目的探讨腹腔镜胆总管一期缝合术中经胆囊管放置细导管(F5输尿管导管)胆道外引流的有效性及安全性。方法回顾性分析2013年2月~2016年3月59例胆囊结石合并胆总管结石患者的临床资料,行腹腔镜胆囊切除+胆总管切开取石一期缝合,经胆囊管放置细导管行胆道外引流。结果全组均手术成功,术后胆汁引流量30~570 ml/d,术后无胆漏、胆管炎、胰腺炎等并发症。术后6~8 d拔管57例,10~11 d拔管2例,无拔管并发症发生。术后住院时间(9.1±2.0)d。全组随访5个月~3年,平均16个月,B超检查无胆管残余结石,肝功能均正常。结论经胆囊管放置细导管胆道外引流,是一种简易、安全及有效的胆道外引流方式,可以消除胆总管一期缝合术后胆漏的潜在风险。Objective To investigate the effectiveness and safety of the slender external biliary drainage tube （F5 ureter catheter） inserted into the common bile duct via the cystic duct in laparoscopic choledochotomy with primary closure. Methods Clinical data of 59 patients with cholecystolithiasis and choledocholithiasis treated in our hospital between Feburary 2013 and March 2016 were retrospectively analyzed. The patients were treated with laparoscopic common bile duct exploration followed by primary duct closure, and bile duct drainage with a slender catheter through cystic duct after closure of the choledochotomy. Results All the cases underwent surgery successfully. The postoperative output of bile drainage was 30 - 570 ml/d. There were no complications such as biliary leakage, cholangitis or biliary pancreatitis. The catheter was withdrawn in 6 - 8 d in 57 patients after the operation, and was withdrawn in 10 - 11 d in 2 patients after the operation. There was no discomfort after removing the catheter. Postoperative hospitalization time was （9.1 ±2.0） d. All patients were followed up for 5 months to 3 years, with an average of 16 months. The Bultrasound examinations showed no residual bile duct stones and liver functions were normal. Conclusions External biliary drainage using a slender ureter catheter via the cystic duct is safe, effective and easy to perform. It may reduce postoperative potential complications, especially bile leakage.

关 键 词：胆总管切开 腹腔镜 胆道外引流 输尿管导管 一期缝合 

分 类 号：R657.4[医药卫生—外科学]