腹腔镜胆总管探查取石的技术改进  

Technical improvement of laparoscopic common bile duct exploration and choledocholithotomy

作　　者：杨颖[1] 罗倩 付庆江[1] 曹立瀛[1] 李振华[1] YANG Yin;LUO Qian;FU Qing-jiang(Department of Hepatobiliary Surgery,Kailuan General Hospital,Hebei United University,Tangshan 063000,China)

机构地区：[1]开滦总医院中西医结合肝胆外科病区,唐山063000

出　　处：《肝胆外科杂志》2023年第1期37-39,44,共4页Journal of Hepatobiliary Surgery

摘　　要：目的探讨组织闭合夹形成胆总管结石的成因及处理策略.方法回顾性分析2019年12月~2020年6月开滦总医院肝胆外科对68例有胆囊结石、胆总管结石的患者实施"无夹"腹腔镜胆总管切开取石术,其中实施胆管一期缝合组与T管引流组各34例.术中缝合结扎全部采用4-0或5-0 PDSII可吸收缝线.结果68例患者均成功完成既定手术,均顺利康复出院,截止随访日无胆漏、肠漏、出血、肠梗阻、切口感染、胆道狭窄及再发结石等并发症发生.留置T管组发现一名患者有残余结石,经胆道镜顺利取石,一期缝合组未见残余结石.结论"无夹"腹腔镜胆总管切开取石术避免了Hem-o-lok引起的胆管内结石,减少了医源性胆总管结石的发生率.Objective To explore the causes and treatment strategies of common bile duct Hem-o-lok stones.Methods Clinical data of 68 patients with gallstones and common bile duct stones underwent“non clip”laparoscopic Choledocholithotomy,including 34 cases in the primary suture group and 34 cases in the T-tube drainage group from December 2019 to June 2020 in our hospital.4-0 or 5-0 PDSII absorbable suture was used for intraoperative suture and ligation.Results All 68 patients successfully completed the established operation,recovered and discharged smoothly.As of the follow-up date,there were no complications such as bile leakage,intestinal leakage,bleeding,intestinal obstruction,incision infection,biliary stricture and recurrent stones.One patient was found to have residual stones in the indwelling T-tube group,and the stones were successfully removed through choledochoscopy.No residual stones were found in the primary suture group.Conclusions“Clip Free”laparoscopic choledocholithotomy can avoid chole-docholithiasis caused by Hem-o-lok and reduce the incidence of iatrogenic choledocholithiasis.

关 键 词：胆总管结石 复发 医源性 预防 

分 类 号：R657.9[医药卫生—外科学]