腹腔镜胆总管切开取石及内置管引流术—一种胆总管探查术后引流的新方法  

Laparoscopic choledocholithotomy (LCH) with internal-tube drainage (LCHID):--A new technique for drainage after LCH

作　　者：周汉新[1] 彭毅[1] 叶建宇[1] 周晓初[1] 钟立明[1] 张风涛[1] 尹耀新[1] 熊沛[1] 

机构地区：[1]北京大学深圳医院腔镜外科中心,深圳518036

出　　处：《中国微创外科杂志》2001年第6期373-375,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的　探讨腹腔镜胆总管切开取石术后既能一期缝合胆总管又能有效引流的新方法。　方法　随机对 2 5例慢性胆囊炎、胆囊结石合并胆总管结石患者施行腹腔镜胆囊切除、胆总管切开、纤维胆道镜探查取石术及分别以T管或内置管引流并观察疗效。　结果　除 1例因Mirizzi综合征中转开腹外 ,2 4例均获成功。其中 1例胆总管未置任何引流而一期缝合 ;4例置T管引流 ;19例采用自制带单向倒勾的 (3～ 5 )mm直径硅胶管内置管引流并一期缝合胆总管。手术时间 (90～ 42 0 )分钟 ,平均 145分钟。胆总管内取出结石 1- 5颗。患者平均住院 7.5天。　结论　腹腔镜胆总管切开取石内置管引流术 ,是一种安全实用、简便易行且符合人体生理的胆总管探查术后引流的新方法。Objective To study a new method for internal drainage and primary suture after laparoscopic choledocholithotomy (LCH). Methods Twenty-five patients with chronic cholecystitis combined with cholecystolithiasis and choledocholithiasis were performed laparoscopic cholecystectomy and choledocholithotomy and extraction of stones with choledoscopy. Results One case of Mirizzi' syndrome converted into laporotomy and 24 cases were successfully performed. Excluding neither internal nor external drainage was carried out with primary closure of common bile duct (CBD) in 1 case and T-tube were placed in 4 cases, the made-self 3mm～5mm diameter silica tubes with one-way hook were placed into the common bile duct for internally drainage in 19 cases. The time of operation was from 90 to 420 minutes with a mean of 145 minutes. 1～5 calculus were removed from CBD. A mean of hospitalized days stay was 7.5 day. Conclusions The operation of internal-tube drainage of LCH frees either the inevitably risk of hyper pressure of biliary duct because of the spasm of Oddi's sphincter or disadvantage of T-tube for drainage after LCH, which is new method both safety and practicality, both simpleness and easiness, and accords with the physiological needs of the human body.

关 键 词：腹腔镜 胆总管切开取石术 内置管引流术 胆总管探查 慢性胆囊炎 胆囊结石 胆总管结石 

分 类 号：R657.42[医药卫生—外科学]