摘要
目的探讨腹腔镜胆总管切开探查手术的方法与优缺点。方法选择胆管结石或胆道蛔虫患者行腹腔镜胆总管切开探查术。结果 50例患者中48例术中取出直径为0.6～2.9cm的结石1～11枚、2例患者术中取出死蛔虫1、2条,有6例患者因结石嵌顿或取石网故障,术中无法取净结石,其中2例肋缘下作一6cm小切口开腹取净、4例术后经T管窦道取净结石,1例患者中转开腹止血。手术时间117.2(45—180)min,术后6.8(3～12)d出院,30例患者置T管引流。未置T管直接缝合胆总管20例,1例出现轻度胆汁渗漏。结论腹腔镜胆总管切开探查取石术是安全的,患者术后痛苦小,恢复快、住院期短,部分患者不置T管直接缝合胆总管更加体现微创效果。
Objective To study how to manage laparoscopic common bile duct(CBD)exploration.Methods Laparoscopy were perfomed on 48 patients with CBD stones and 2 with biliary ascariasis.An incision from which fiberoptic endoscopy could be inserted to the biliary duct was made in the anterior wall of the CBD.The stones and ascariases were removed by the forceps or basket.Results The span of operation time was 117.2(45～180)min.The average length of postoperative stay was 6.8(3-12)days.One to eleven calculus(0.6～2.9cm)in 48 cases and 1～2 ascariases in two case were taken out.Four cases had a retained stone.Two cases had a converted operation.The 20 cases of CBD were primary sutured after removing stones or ascariases.There were no death record.One patient who received biliary tract operation 20 years ago was converted into open hemostasis.One case with one-layer-suture had mild biliary fistula and was cured by means of conservative treatment.Conclusions Our experiences revealed that laparoscopic common bile duct exploration is safe and efficient.It has been shown that primary suture of CBD some patients is safe with advantage of short postoperative stay,mild pain and rapid recovery,and the two layers suture of CBD can avoid the development of biliary fistula.
出处
《现代消化及介入诊疗》
2001年第1期23-25,共3页
Modern Interventional Diagnosis and Treatment in Gastroenterology
