腹腔镜胆管探查术中的问题及对策(附71例报告)  

PROBLEMS AND MANAGEMENT WITH 71 CASES OF LAPAROSCOPIC COMMON BILE DUCT EXPLORATION

作　　者：胡明彦[1] 陈斌[1] 田爱林[1] 石正军[1] 林学军[1] 戴少华[1] 王建强[1] 

机构地区：[1]江汉石油管理局中心医院腹腔镜诊疗中心,433121

出　　处：《中国内镜杂志》2002年第12期44-45,55,共3页China Journal of Endoscopy

摘　　要：目的 :探讨腹腔镜胆管探查术中常见问题的处理方法。方法 :对 71例腹腔镜胆管探查患者 ,比较其胆管切开方法的差别 ,观察术中胆道造影的价值 ,分析一期缝合胆总管的结果。结果 :71例中 70例取出结石 ,全部病人痊愈。胆管壁直接尖刀切开、电凝胆管壁上的小血管后以专用尖刀或弯剪刀切开胆总管、从胆管穿刺针眼处直接电钩钩开部分胆管壁、超声刀分离胆管前壁后从穿刺针眼处切开胆管等四种胆管切开方法以后二种方法最为方便快捷。行术中胆管造影发现胆管结石 11例 ,全部为术前超声检查及术中观察胆管直径在8～ 11mm者。 9例一期缝合胆总管 ,发生胆漏 2例 (为 2 2 .2 % ) ,明显高于放置T管组。结论 :腹腔镜胆管探查术是安全、有效的手术方法 ,病人痛苦小、恢复快。电钩直接钩开胆管壁是最为方便快捷的胆管切开方法 :术中胆管造影应选择性使用 ;直接缝合胆总管胆漏发生率较高 ,应严格控制使用。Objective: To study the problems and management in laparoscopic common bile duct (CBD) exploration. Methods: The incisioned methods of CBD were compared and value of choledochography in operation were observed. The outcome of primary suture were analysed. Results: The stones were extracted in 70 Of 71 cases and all recover. The measure hook electrode carve in the front wall of CBD is best in four technique. Eleven cases were found by choledochography in operation. Two cases had fistula and were cured by means of conservative treatment in 11 cases with primary suture. Conclusion: Laparoscopic common bile duct exploration is safe and efficient. The hook electrode carve in the front wall of CBD is convenience and shortcut. The choledochography in operation would be used selective. Primary suture would be used in control because high morbidity of bile fistula.

关 键 词：腹腔镜检查术 胆管切开术 胆石症 

分 类 号：R657.42[医药卫生—外科学]