腹腔镜胆总管探查的临床价值(附530例报告)  

Clinical value of laparoscopic common bile duct exploration: A retrospective study of 530 cases

作　　者：尹思能[1] 李青亮[1] 张诗诚[1] 蔡斌[1] 易斌[1] 郑坚[1] 李涛[1] 肖宏[1] 陈先林[1] 赵晓峰[1] 

机构地区：[1]成都市第二人民医院肝胆胰外科,成都610017

出　　处：《中国微创外科杂志》2003年第2期122-124,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的　评价腹腔镜胆总管探查的临床价值。　方法　 1992年 3月～ 2 0 0 1年 5月无选择经随访后的腹腔镜胆总管探查 5 30例 ,其中置T管 2 2 2例 ,术后 2月拔T管 ,并常规作胆道镜检 ;胆管I期缝合 30 2例 ,术后 3月作静脉胆道造影或B超随访 ;经胆囊管探查 6例。　结果　中转开腹率 0 4 % ( 2 / 5 30 )。胆管阴性探查率 4 0 % ( 2 1/ 5 30 )。术中结石取净率 85 3 %( 434/ 5 0 9)。胆管再生结石率 0 8% ( 4/ 5 30 )。手术并发症率 13 6 % ( 72 / 5 30 ) ,死亡率 0 4 % ( 2 / 5 30 )。 5 30例随访 ( 3 5± 0 3)年 ,无胆管狭窄。　结论　腹腔镜胆总管探查创伤小、并发症率和死亡率低 ,半数以上可作胆管I期缝合。Objective To evaluate the clinical value of laparoscopic common bile duct exploration (LCDE). Methods LCDE was completed in 530 cases, with follow-up between March 1992 and May 2001 in this hospital. T-tube drainages were performed in 222 cases and T-tubes were removed 2 months postoperatively, followed by routine choledochoscopy to ensure the bile duct free of stones; primary bile duct sutures were performed in 302 cases, followed by intravenous cholangiography (IVC) or ultrasonogram 3 months postoperatively.The common bile ducts of other 6 cases were explored through cystic duct. Results Conversions to open operations were required in 2 cases (0.4%). There were 21 explorations with negative results (4.0%). Stones were removed completely in 434 cases (85.3%). Complications were found in 72 cases (13.6%). Mortality 0.4%. None of 530 cases was found postoperative bile duct stricture in follow-up (3.5±0.3 years). Conclusions LCDE is growing up as a safe and effective approach with minimal invasion, fewer complications and low mortality for patients with choledocholithiasis, and primary duct suture could be performed in more than half cases.

关 键 词：腹腔镜 胆总管探查 临床价值 胆管结石 

分 类 号：R657.4[医药卫生—外科学]