摘要
目的探讨腹腔镜胆总管探查后以胆道内支架替代 T 管引流的可行性。方法40例胆总管结石病人随机分为 A、B 两组,在腹腔镜下完成胆总管探查、取石后,A 组(20例)常规置入 T管;B 组(20例)经胆道镜将胆道造影管通过胆总管进入十二指肠,并带入导丝。在胆道镜监视下利用推送器(pusher)沿导丝将 Endo-Flex 胆道内支架安置于胆总管远端,并使支架头部侧翼进入十二指肠.胆总管切口一期缝合。对两组平均住院时间、术后2周肝功能指标及并发症情况进行统计学分析。结果两组术后2周肝功能指标及胆漏发生率无显著性差异(P>0.05),B 组较 A 组有更短的平均住院日(P<0.05)。2例胆漏病人经短期引流后治愈。胆道支架于术后2~3周以圈套器取出。术后随访2~39个月,无结石复发和胆道狭窄。结论应用胆道内支架行腹腔镜胆总管探查是治疗胆总管结石的一种有效、可行的方法。
Objective To investigate the feasibility of using endobiliary stent for laparoscopic exploration of common bile duct. Methods Forty patients with common bile duct stones (CBDS) were randomized into 2 groups. In group A (n=20), a T-tube was routinely placed after LCBDE and clearance of stones were accomplished. In group B (n=20), the cholangiogram catheter was led into duodenum through the choledochoscope and the guidewire was directed through the wire port of the cholangiogram catheter subsequently. Monitoring by the choledochoscope, the Endo-Flex endobiliary stent was advanced over the guidewire until its distal tip entered the duodenum and the distal flange cleared the ampulla. The common bile duct was primarily closed. The average hospital stay, liver functional index and complications were determined in both groups and compared between the 2 groups. Results There was no significant difference in the liver functional index between the 2 groups in 2 weeks postoperatively (P〉0. 05). The average hospital stay was markedly shorter in group B than in group A (P〈0. 05). Two patients suffered from bile leakage and recovered by short-period drainage. The stent was removed using a snare 2-3 weeks postoperatively. The follow-up for 2-39 months showed no stone recurrence and bile duct stenosis. Conclusions LCBDE with endobiliary stent is an effective and feasible alternative for management of CBDS.
出处
《中华肝胆外科杂志》
CAS
CSCD
2006年第1期21-23,共3页
Chinese Journal of Hepatobiliary Surgery
关键词
腹腔镜术
胆道支架
胆总管结石
Laparoscopy
Endobiliary stent
Common bile duct stone