胆总管结石切开探查取石后一期缝合治疗胆总管结石的临床研究(1)
摘要：目的：探讨胆总管切开探查取石后一期缝合治疗胆总管结石的临床疗效，方法： 对我院自2013年1月-2014年6月75例具有胆道探查指征的患者，实施开腹或腹腔镜下胆总管切开、胆道镜探查取石，探查结束后不放置T管而用4-0或5-0的可吸收缝合线一期缝合。观察住院天数，患者术后引流天数、住院费用等指标。评价胆总管一期缝合治疗胆总管结石的优缺点。结果 ：74例痊愈出院，1例术后发现胆漏经保守治疗后治愈出院，平均手术时间开腹组为103分钟，腹腔镜组为92分钟，平均术后住院时间开腹组8天，腹腔镜组4天，腹腔引流时间两组都是3天。术后随访均超过6个月。B超示无胆绞痛、黄疸发生，无结石残留及复发，无胆总管狭窄。结论： 胆总管切开取石一期缝合治疗胆总管结石安全、有效。值得广泛应用推广。
关键词：胆管结石 一期缝合 腹腔镜 胆道镜
Abstract： Objective ：clinical research of primary suture of the incision on common bile duct in common bile duct stones; Methods ：An incision of 15mm was made on the common bile duct in 75 patients who had indication for exploration from Jan 2013 to June 2014 then the choledochoscope was placed into common bile duct through this incision . The incision was directly sewed up after the exploration with 4-0 or 5-0 absorbable suture. Results ：Stone were all dislodgment.74 patients were curried and 1patient was appearance bile leakage，but by treat of conservation was curried. The average operating time？of open group was 103 minutes and laparoscopic group was 92 minutes， The mean duration of postoperative hospitalization was of open group was 14 - 19days and laparoscopic group was 4 days. The Peritoneal drainage？f postoperative hospitalization were 4-7 days andaparoscopic group was 3 days. 70 patients were followed up with B- mode ultrasonography for 6 months. It was found that no biliary colic， choloplania， no calculus remain or palindromia and no common bile duct stricture. Conclusion Strictly surgical indications and contraindications of the common bile duct under a suture is a safe and effective selection of operation.worth widely promoted
, 百拇医药
Keywords：Common duct stones primary suture abdominoscope choledochoscope
既往胆总管切开取石探查后常规放置T型管引流，胆汁外引流造成电解质紊乱，术后肠功能恢复减慢。而且代管时间较长。一般要在术后14 -30天后造影或彩超检查后才能拔除，患者住院时间长，花费高，且给生活带来不便。随着胆道外科技术的进步以及生物相容性缝合线的应用， 胆总管切开探查一期缝合胆管在临床广泛应用。为了在基层医院广泛推广。本文对我院2013年1月-2014年6月进行的胆总管结石患者进行胆总管切开取石，一期缝合治疗。取得良好效果。现报道如下：
1 资料和方法
1.1病例资料纳入标准： (1)胆总管结石，不合并肝内胆管结石(2)术前未合并急性胰腺炎或急性化脓性胆管炎;(3)取石完毕后术中胆道镜或胆道造影未见胆管内残留结石;(4)胆道造影或术中胆道镜观察未见胆管下端开口明显狭窄，(5) 胆总管内径8mm以上，黄疸指数在100 mmoL/L以下。
, 百拇医药
1.2病例来源及一般资料：自2013年1月-2014年6月根据上述标准我院对75例病人进行胆总管切开探查取石后胆总管一期缝合治疗。其中男性患者31例，女性患者44例，年龄17-78岁，平均年龄54.4岁，其中原发胆总管结石10例，继发性胆总管结石65例，其中二次胆道手术者5例，主要的诊断方式B超、CT、MRI。
1.3手术方式：
1.3.1开腹组： 本组58例，由右肋缘下切开或经腹直肌切开，开腹后有胆囊者先常规切除胆囊，解剖胆总管经穿刺证实后，于两针牵引缝线间靠近十二指肠上方纵行切开胆总管前壁，长约1.5cm，视情况适当延长切口。结果3例探查阴性，55例发现胆总管结石。1-5枚不等。胆总管均有不同程度扩张，管壁略厚，无明显水肿。其中胆总管直径1.0-1.2 cm者15例，1.2-1.6 cm者28例，1.6-2.0cm者15例。通过取石钳、胆道镜网石篮等取石器械取尽结石，彻底冲洗，再次用胆道镜探查，证实左右肝管无结石残留，通畅无狭窄，胆总管通畅无残余结石，乳头内口形状规则色泽正常下端可通过20号导尿管并注水证明下端oddi氏括约肌功能完好。切口用5-0的可吸收缝线，间断全层缝合，针距边距约1.5-3 mm，以不漏胆汁为度，术后常规于winslow孔留置硅胶引流管，下端可通过20号导尿管并注水证明下端oddi氏括约肌功能完好。切口用5-0的可吸收缝线，间断全层缝合，针距边距约1.5-3 mm，以不漏胆汁为度，术后常规于winslow孔留置硅胶引流管。手术时间90m-120m，平均时间103m。, http://www.100md.com(李传光 张锋刚 王介营 韩双喜 王长征 王玉虎)
关键词：胆管结石 一期缝合 腹腔镜 胆道镜
Abstract： Objective ：clinical research of primary suture of the incision on common bile duct in common bile duct stones; Methods ：An incision of 15mm was made on the common bile duct in 75 patients who had indication for exploration from Jan 2013 to June 2014 then the choledochoscope was placed into common bile duct through this incision . The incision was directly sewed up after the exploration with 4-0 or 5-0 absorbable suture. Results ：Stone were all dislodgment.74 patients were curried and 1patient was appearance bile leakage，but by treat of conservation was curried. The average operating time？of open group was 103 minutes and laparoscopic group was 92 minutes， The mean duration of postoperative hospitalization was of open group was 14 - 19days and laparoscopic group was 4 days. The Peritoneal drainage？f postoperative hospitalization were 4-7 days andaparoscopic group was 3 days. 70 patients were followed up with B- mode ultrasonography for 6 months. It was found that no biliary colic， choloplania， no calculus remain or palindromia and no common bile duct stricture. Conclusion Strictly surgical indications and contraindications of the common bile duct under a suture is a safe and effective selection of operation.worth widely promoted
, 百拇医药
Keywords：Common duct stones primary suture abdominoscope choledochoscope
既往胆总管切开取石探查后常规放置T型管引流，胆汁外引流造成电解质紊乱，术后肠功能恢复减慢。而且代管时间较长。一般要在术后14 -30天后造影或彩超检查后才能拔除，患者住院时间长，花费高，且给生活带来不便。随着胆道外科技术的进步以及生物相容性缝合线的应用， 胆总管切开探查一期缝合胆管在临床广泛应用。为了在基层医院广泛推广。本文对我院2013年1月-2014年6月进行的胆总管结石患者进行胆总管切开取石，一期缝合治疗。取得良好效果。现报道如下：
1 资料和方法
1.1病例资料纳入标准： (1)胆总管结石，不合并肝内胆管结石(2)术前未合并急性胰腺炎或急性化脓性胆管炎;(3)取石完毕后术中胆道镜或胆道造影未见胆管内残留结石;(4)胆道造影或术中胆道镜观察未见胆管下端开口明显狭窄，(5) 胆总管内径8mm以上，黄疸指数在100 mmoL/L以下。
, 百拇医药
1.2病例来源及一般资料：自2013年1月-2014年6月根据上述标准我院对75例病人进行胆总管切开探查取石后胆总管一期缝合治疗。其中男性患者31例，女性患者44例，年龄17-78岁，平均年龄54.4岁，其中原发胆总管结石10例，继发性胆总管结石65例，其中二次胆道手术者5例，主要的诊断方式B超、CT、MRI。
1.3手术方式：
1.3.1开腹组： 本组58例，由右肋缘下切开或经腹直肌切开，开腹后有胆囊者先常规切除胆囊，解剖胆总管经穿刺证实后，于两针牵引缝线间靠近十二指肠上方纵行切开胆总管前壁，长约1.5cm，视情况适当延长切口。结果3例探查阴性，55例发现胆总管结石。1-5枚不等。胆总管均有不同程度扩张，管壁略厚，无明显水肿。其中胆总管直径1.0-1.2 cm者15例，1.2-1.6 cm者28例，1.6-2.0cm者15例。通过取石钳、胆道镜网石篮等取石器械取尽结石，彻底冲洗，再次用胆道镜探查，证实左右肝管无结石残留，通畅无狭窄，胆总管通畅无残余结石，乳头内口形状规则色泽正常下端可通过20号导尿管并注水证明下端oddi氏括约肌功能完好。切口用5-0的可吸收缝线，间断全层缝合，针距边距约1.5-3 mm，以不漏胆汁为度，术后常规于winslow孔留置硅胶引流管，下端可通过20号导尿管并注水证明下端oddi氏括约肌功能完好。切口用5-0的可吸收缝线，间断全层缝合，针距边距约1.5-3 mm，以不漏胆汁为度，术后常规于winslow孔留置硅胶引流管。手术时间90m-120m，平均时间103m。, http://www.100md.com(李传光 张锋刚 王介营 韩双喜 王长征 王玉虎)