腹腔镜下胆总管探查一期缝合术并胆道内双J管内引流术的临床的研究.pdfVIP

腹腔镜下胆总管探查一期缝合术并胆道内双J 管内引流术的临床研究 汤可立 石承先 徐贤刚 赵鹏伟李克跃 贵州省人民医院肝胆外科 贵州 贵阳 550002 摘要:目的：探讨腹腔镜下胆总管探查取石、一期缝合并胆道内双J管内引流术的可行性和临床疗效。方法：回顾性 分析我院2008年9月至2012年5月收治的45例胆总管直径大于8mm的胆总管结石患者施行腹腔镜下胆囊切除、胆总管切 开、胆道镜取石、胆道内双J管内引流术，总结该术式的适应证、操作技术及临床疗效。并将之与其它术式进行比较 分析。结果：45例患者中42手术获成功，1例中转开腹，2例改成放T管，术中取尽结石，术后未发现胆漏、胆道狭窄 或残余结石。胆道内双J管40例于术后5-7天在胃镜下拔出，2例在术后1周内随大便自行排出。结论：对于胆总管直径 大于0.8cm，胆囊结石合并胆总管结石的病例，腹腔镜下胆总管切开探查取石、胆总管一期缝合、双J管内引流术是 可行的，能缩短住院时间，降低医疗费用。 腹腔镜术;胆总管结石;胆道内引流;一期缝合 Theclinicalapplicationofcommonbileductexploration,primarysutureofcommon bileductandbiliarystentdrainagewithdoubleJtubebylaparoscope TANGKe-liSHiCheng-xianXUXian-gangZHAOPeng-weiLIKe-yue DepartmentoftheHepatobiliarySurgery.TheGuizhouProvincialPeoples HospitalGuiyangGuizhou550002,China Abstract:Objective:Toexplorethefeasibilityandclinicaleffectivenessofcommonbileductexploration,primarysutureof commonbileductandbiliarystentdrainagewithdoubleJtubebylaparoscope.Methods:FromSep.2008toMay.2012,45 patientsofcommonductstoneswhosecommonbileductdiametergreaterthan8mmwereenrolledinthisstudy,andwere comparedtoothersurgicalprocedures.Results:Theprocedurewasaccomplishedinall42patientsexcept3patientwithno residualstones,nobilefistulaandnobiliarystricture.ThedoubleJtubewasdrewoutbygastroscopein40cases,andthe remaining2stentswereexcretedbystool1weekafteroperation.Conclusions:Itisfeasibletoperformlaparoscopic commonbileductexplorationandstoneremoval,biliarystentdrainagewithdoubleJtubeandprimarysutureofcommon bileductforthepatientofcholecystolithiasismergereholedocholithiasis,whosecommonbileductdiametergreaterthan8 mm.Comparedwithotherminimallyinvasiveprocedures,itisaeffectivemethodandcanshortenhospitalstay,decreasethe medicalcost. Keywords:Laparoscopy;Calculusofcommonbileduct;Endobiliarydrainage;Primarysuture 疗胆漏； C ，3.4欧洲内镜 隙极治疗‘训。随； 董取石、“T”管j ~nMH.Cornt l].BrJStag,