胆总管探查胆管一期缝合术的治疗体会.docVIP

精品论文 参考文献 胆总管探查胆管一期缝合术的治疗体会 罗坤（四川安岳县人民医院肝胆外科 四川资阳 642350） 【摘要】目的 探讨胆总管一期缝合的疗效及临床适用人群。方法 回顾性分析我院80例胆总管结石患者。40例行一期胆总管缝合术，40例患者行T管引流术。观察术后胆汁漏、胆管狭窄、胆管残余结石等指标。结果 胆汁漏及胆总管残余结石二者均无显著性差异（Pgt;0.05）；二组均无胆管狭窄发生；住院时间胆总管一期缝合组较胆总管T管引流组明显缩短；住院费用胆总管一期缝合组较胆总管T管引流组明显减少。结论 胆总管直径大于1.8cm者进行胆总管一期缝合的疗效与T管引流术无差异，并可以有效降低住院时间和减少住院费用。 【关键词】胆总管探查 胆管一期缝合 治疗体会 【中图分类号】R657.4【文献标识码】A【文章编号】1672-5085（2012）18-0039-02 The Treatment Experience of Primary Suture after Exploratory Choledochotomy 【Abstract】　Objective: Discuss the curative effect of primary suture and the clinical applicable people.Methods: 80 patients of choledocholithiasis were analyzed retrospectively.40 patients were operated by primary suture after choledochotomy.40 patients were operated by T-tube drainage for choledochotomy.Observe whether patients had bile leakage,biliary stricture,retained calculus or not.Result: The rate of bile leakage and biliary stricture were no significant difference (Pgt;0.05).There was no biliary stricture in two groups.The hospital stays and hospitalization expenses of primary suture group were significant reduced (Plt;0.05).Conclusion: The curative effect of primary suture was no significant difference compared with T-tube drainage for choledochotomy when the diameter of common bile duct was more than 1.8cm.The hospital stays and hospitalization expenses of primary suture group were significant reduced. 【Key words】　Exploratory Choledochotomy Primary Suture the Treatment Experience 胆总管探查术胆管一期缝合术在全国尚未得到广泛认可。但是随着胆总管T管引流术的诸多缺点及并发症的出现，胆总管一期缝合术已被广泛关注，接受并应用。我们选取我院2008年以来80名胆总管结石患者进行回顾性研究，来探讨胆总管一期缝合的疗效及适应人群。 1﹑资料与方法 1.1 一般资料 我院2008年以来80例胆总管结石患者进行回顾性研究，80例胆总管结石患者均无肝内胆管结石。其中胆总管探查后T管引流患者40例，胆总管探查术后一期缝合患者40例，均为第一次手术，且两组年龄﹑Child肝功能评分（见表1 ）﹑两组胆总管直径（腹部彩超）比较均无显著性差异（见表2 ）。 表1 Child肝功能评分标准 表2 两组临床资料比较 1.2 治疗方法 胆总管结石若合并胆囊结石，首先常规切除胆囊（做到胆囊管不留过长）。剪开肝十二指肠韧带，穿刺抽出胆汁证实为胆总管后，1号丝线缝合胆总管前壁作牵引，在两根牵引线间切开胆总管前壁并延长到2-3cm左右，用取石钳取净胆总管结石，胆总管放置导尿管用温盐水反复冲洗多次，胆总管下端能通过4-9#