[1]纪红宇,朱宏,刘艳芳,等.腹腔镜胆总管探查Ⅰ期缝合术治疗胆总管结石中长期随访报告[J].中国微创外科杂志,2012,12(5):434-443.
　Ji Hongyu*,Zhu Hong*,Liu Yanfang,et al.Laparoscopic Exploration and Primary Suture for Common Bile Duct Stones: Report of Mid and Longterm Follow-up[J].Chinese Journal of Minimally Invasive Surgery,2012,12(5):434-443.
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腹腔镜胆总管探查Ⅰ期缝合术治疗胆总管结石中长期随访报告()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
12
期数:
2012年5期
页码:
434-443
栏目:
出版日期:
2012-05-25

文章信息/Info

Title:
Laparoscopic Exploration and Primary Suture for Common Bile Duct Stones: Report of Mid and Longterm Follow-up
作者:
纪红宇; 朱宏; 刘艳芳; 王超一
沈阳市第五人民医院普外二科， 沈阳 110023
Author(s):
Ji Hongyu*;  Zhu Hong*;  Liu Yanfang;  et al.
*Second Department of General Surgery, Shenyang Fifth People’s Hospital, Shenyang 110023, China
关键词:
腹腔镜; 胆总管结石; 胆总管探查; 胆总管Ⅰ期缝合术
Keywords:
Laparoscopy; Common bile duct stones; Common bile duct exploration; Primary suture of the common bile duct
分类号:
R657.4
文献标志码:
A
摘要:
目的探讨腹腔镜胆总管探查Ⅰ期缝合术治疗胆总管结石的中长期效果。方法2005年1月~2010年12月对89例胆总管结石常规四孔法行腹腔镜胆囊切除及胆总管探查，钬激光碎石联合胆道镜取石，50或40可吸收带针线8字或连续扣锁缝合胆总管。结果手术时间80~210 min，平均110 min；术中出血量20～220 ml，平均50 ml。术后胆漏6例（60~150 ml/d），经保守治疗后腹腔引流管拔除时间4~8 d，平均5.1 d；余83例均在术后3~4 d拔除腹腔引流管；无大出血及胆管损伤。85例随访1~6年，平均3.2年，其中随访1~3年32例，>3~5年40例，>5年13例：9例有上腹部疼痛史1~2次，未经治疗自行缓解；12例因腹痛就诊1次，其中7例诊断为胆系感染，经抗炎治疗后好转，另外5例术后8～38个月（平均15个月）胆总管结石复发，其中2例胆总管结石＜1.0 cm行EST，3例因结石较大或多枚开腹手术治疗，预后均良好；术后肝功能正常76例，轻度肝功能损害7例，重度度肝功能损害2例；超声检查示63例胆总管直径＜1.5 cm，22例胆总管直径≥1.5 cm，其中2例胆总管直径≥2.0 cm经手术证实为胆总管多枚结石复发。结论腹腔镜胆总管探查Ⅰ期缝合术是一种安全可靠的治疗方法，应严格把握适应证，术中取净结石。
Abstract:
ObjectiveTo study mid and longterm outcomes of laparoscopic exploration plus primary suture for the treatment of common bile duct stones. MethodsWe analyzed the clinical data of 89 patients with common bile duct stones, who received fourport laparoscopic cholecystectomy (LC) and common bile duct exploration, from January 2005 to December 2010.Holmium laser lithotripsy combined with choledochoscopic stone extraction and 50 or 40 absorbable suture were used for the procedure.ResultsThe operation time ranged from 80 to 210 min with a mean of 110 min. The intraoperative blood loss ranged from 20 to 220 ml with a mean of 50 ml. Postoperative bile leakage occurred in six patients (60-150 ml/d), who were then cured by conservative treatment and the abdominal drainage for 4 to 8 days (mean, 5.1 days); the other 83 patients received abdominal drainage for 3 to 4 days; none of the patients had hemorrhage or injury to the bile duct. We followed up 85 of the patients for a mean of 3.2 years(1-6 years; 1-3 years in 32 patients, >3-5 years in 40 patients, and >5 years in the other 13); during which 9 patients complained of upper abdominal pain for once or twice, and were cured spontaneously; 12 patients went back to hospital for abdominal pain for once, 7 of them were diagnosed with biliary infection, and were cured by antiinflammation, and the other 5 received a second operation for recurrent common bile duct stones with EST(2 cases of the stones <1.0 cm in diameter) or open surgery (3 cases of big or multiple stones). The recurrence occurred in 8-83 months(mean, 15 months). Postoperative examination showed normal liver function in 76 patients, mild liver dysfunction in 7, and severe liver dysfunction in 2; and ultrasonography showed that the common bile duct was ＜1.5 cm in diameter in 63 patients, and ≥1.5 cm in 22 cases (2 of them were confirmed with multiple recurrent stones). ConclusionsLaparoscopic exploration plus primary suture is safe and effective. The two keys to the procedure are strict indications for the procedure and completely stone clearance.

参考文献/References:

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备注/Memo

备注/Memo:
朱宏通讯作者，Email:165163929@qq.com 刘艳芳手术室
更新日期/Last Update: 2013-04-03