腹腔镜下经胆囊管肝总管汇合部微切开胆总管探查的可行性.pdf

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1、中国普外基础与临床杂志2013年11月第2O卷第11期ChinJBasesClinGeneralSurg，Vo1．20，No．11，Nov．2013·1287·论著腹腔镜下经胆囊管肝总管汇合部微切开胆总管探查的可行性卢铁成，周天民，吴尚卫【摘要】目的探讨腹腔镜下经胆囊管肝总管汇合部微切开胆总管探查免置T管的可行性及病例选择。方法回顾性分析我院2009年1月至2011年12月期间52例拟行胆总管探查患者的临床资料，实施了经腹腔镜、胆道镜双镜联合下经胆囊管肝总管汇合部微(3～4mm)切开取石、不放置T管引流，一期缝合。

2、结果本组52例患者术中无阴性探查，术中使用胆道镜及胆道造影检查证实结石完全取出，结石取净率为100％，手术时间为90～200min，平均100min。术中胆道造影时间为3～10min，平均6min。胆道镜协助取石时间为5～15min，平均8min。术后腹腔引流管拔管时间3～5d，平均3．5d。术后腹腔引流液量为20～60mL／d，平均30mL／d。术后无胆汁漏、腹痛、黄疸及切口感染发生。术后住院5～12d，平均6．5d。术后随访时间为3～40个月，平均20个月，无结石再生或胆管狭窄发生。结论若术者腹腔镜、胆道镜技术

3、熟练，手术病例选择适当，术中检查仔细，冲洗干净，经胆囊管肝总管汇合部微切开取石后行胆总管一期缝合是安全、可行的。【关键词】腹腔镜；胆总管探查；一期缝合【中图分类号】R657．4【文献标志码】AFeasibilityThroughConfluenceofCommonBileDuctandCysticDuctApproachwithMini—IncisioninLaparoscopicCommonBileDuctExplorationLUP．cheng’。ZHOUTian—min．WUShang-wei’．TheFir

4、stPeopleHospitalofTianshui，Tianshui741000，GansuProvince，ChinaCorrespondingAuthor：LU乃P—cheng．E—mail：wⅥ1003886345@qq．com[Abstract]ObjeetiveToinvestigatethefeasibilityandpatientselectionofT-tubefreelaparoscopiccommonbileductexplorationthroughmini．incisioninconflu

5、enceofcommonbileduct(CBD)andcysticduct．MethodsTheclinicaldataof52patientswhounderwentCBDexplorationfromJanuary2009toDecember2011wereretrospectivelyanalyzed．A3—4mmlongitudinalincisionofanteriorwallofCBDwasmadealongtheconfluenceofCBDandcysticduct，andthenthechole

6、dochoscopewasinsertedintoCBDthroughthismini—incisionfortheexplorationandtreatmentbylaparoscopyandcholedOch0scopy，theincisionwassewedupbyT-tubefreeprimarysuture．ResultsAll52easeswerecuredandstoneclearanceratewas100％asrevealedbycholedochoscopyandcholangiography．

7、Thetimeofoperation，intraoperativecholangiography，removalofstoneswithhelpofchOledochoscOpe，andremovaldrainagetubeafteroperationwasfrom90to200minwithanaverageof100min．3to10minwithanaverageof6min，5to15minwithanaverageof8min，and3-5dwithanaverageof3．5d，respectively

8、．Thedrainageflowwas20—60mL／dwithanaverageof30mL／d．Nobiliaryleakage，abdominalpain，andcholoplaniaorinfectionofincisionwasobservedfollowingoperation．Thehospitalstaywas5to12dwithanaver