腹腔镜胆总管切开取石一期缝合术治疗胆总管结石53例分析

目的：探讨腹腔镜胆总管切开取石一期缝合术治疗胆总管结石的可行性及安全性。方法：回顾分析2009年12月至2012年8月为53例胆囊结石合并胆总管结石患者行腹腔镜、纤维胆道镜联合治疗的临床资料。腹腔镜胆囊切除联合胆总管切开,经胆道镜置入取石网篮取石,术毕一期缝合胆总管。结果：本组腹腔镜胆道镜联合胆总管探查取石术成功率98.1%（52/53）,1例中转开腹留置T管。手术时间平均（89.1±46.3）min,术中出血量平均（35±24.9）ml,术后平均住院（6.7±3.1）d,3例发生胆漏,1例再次手术。术后随访4个月～2年,发生残余胆总管结石1例。结论：在严格把握手术指征、认真术前影像学评价、术中熟练胆道镜操作、精准缝合的前提下,腹腔镜胆总管切开取石一期缝合术治疗胆总管结石是安全、可行的。

Analysis of laparoscopic choledocholithotomy and primary suture in the treatment of fifty-three patients with choledocholithiasis

Objective：To explore the feasibility and security for laparoscopic common bile duct exploration and primary suture （LBEPS） in the treatment of common bile duct stones. Methods ： The clinical data of 53 patients with common bile duct stones and gallbladder stones who were treated by laparoscopy and choledochofiberscope from Dec. 2009 to Aug. 2012 were analyzed retrospective- ly. All the patients underwent laparoscopic cholecystectomy combined with common bile duct exploration, removal of stone through cho- ledoehoscope and stones retrieval basket, and primary suture of common bile duct. Results：Ninety-eight point one percent patients （52/53） were treated by LBEPS successfully. Only one case was converted to laparotomy and indwelling T-tube. The mean operative time was （89.1 _＋ 46.3 ） rain,the blood loss was （35 -e 24.9） ml,the postoperative hospital stay was （ 6.7 _＋ 3.1 ） d, three cases suf- fered from bile leakage, one case was re-operated. Postoperative follow-up was 4 months to 2 years, one case had residual common bile duct stones. Conclusions：Under the premise of strict grasping surgical indication, seriously preoperative imaging evaluation, skillful cho- ledochoscope technology and precise suture,it is safe and feasible for LBEPS to treat the patients with common bile duct stones.