生鱼丝剑丛塾塑查垫!!堡!!旦箜!!鲞筮!!塑垦!堕!丛堕些!!!堡：堕!!!璺!!!垫!Q：!!!：!Q：坠：!!·1013·临床论著·腹腔镜下经胆囊管切开胆总管取石胆道一期缝合术陈德兴刘奇董加纯曹春和侯敬袢闰立佳(吉林省前卫医院普外科，长春130012)【摘要】目的探讨腹腔镜下经胆囊管切开胆总管取石，胆道一期缝合治疗胆总管结石的可行性。方法2009年10月一2010年5月对55例胆囊结石合并胆总管结石施行经胆囊管切开且日总管取石胆道一期缝合术。腹腔镜下切除胆囊后，保留且日囊管长1．0一1．5cm，沿胆囊管纵轴剪开胆囊管前壁至胆总管，再沿胆总管纵轴向下切开胆总管0．3—1．1cm，经此切口内镜取净胆道结石并判断Oddi括约肌功能是否正常。从胆总管切开处的下方开始，向胆囊管切开处的盲端方向先行黏膜层缝合，然后肌层缝合，距胆总管0．2cm结扎胆囊管。腹腔放置引流管。结果55例手术均获成功，胆囊管直径0．3—0．6cm，平均0．45cm；胆囊管切开长度1．0一1．5cm，平均1．3em；胆总管切开长度0．3—1．1em，平均0．5cm。腹腔引流管留置3—5d。术前术后MRCP对比胆总管直径无异常改变。1例术后出现胆漏，对症治疗后治愈。术后腹痛、腹胀2例，48h后缓解。1例术后5d出现间歇性腹痛，7d出现黄疽，9d后腹痛缓解，黄疽消退。术后住院时间7—13d，平均8d。55例术后随访1—6个月，平均4．5月，无残余结石及结石复发。结论腹腔镜下经胆囊管切开胆总管取石胆道一期缝合术治疗胆总管结石可行。【关键词】一期缝合；胆总管结石；腹腔镜；胆囊管中图分类号：R657．4文献标识：A文章编号：1009—6604(2010)11—1013—03LaparoscopicTranscysticCholedochotomyandPrimaryDuctalClosureChenDexing，Liuqi，DongJiachun，eta1．DepartmentofGeneralSurgery，jainQianweiHospital。Changchun130012。China【Abstract】0bjectiveToexplorethefeasibilityofremovingbileductstonesthroughanincisiononthecysticductandthensuturetheincisionprimarilybylaparoscopy．MethodsBetweenOctober2009andMay2010，55patientswithstonesinthegallbladderandcommonbileductreceivedlaparoscopiccholedochotomythroushthetranscysticapproach．Duringtheprocedure，aftercholecystectomv．theremaining1．0．to1．5．cmcysticductwascutlongitudinally，andthena0．3-to1．1-cmincisionwasmadeonthecommonbileducttoremovetheductslstones：thefunctionoftheOddi’ssphincterwasdeterminedatthemeantime．Afterremovingthestones，themucosallayerofthecommonbileductwassuturedfollowedbythemuscularlayer，fromthebottomtothetopoftheincisionuntil0．2cmtothecommonbileduetatwhichpointthecysticductwasligated．Aftertheoperation，peritonealdrainagetubewaaplaced．ResultsTheprocedurewascompletedinallofthe55cases．0fthecases．thediameterofthecysticductrangedfromO．3to0．6cm(mean，0．45cm)，andthemeancutlengthonthecysticductwas1．3am(1．0一1．5cm)．Themeanlengthoftheincisiononthecommonbileductwas0．5cm(0．3—1．1cm)．Theperitonealtubewaswithdrawnin3to5daysahertheoperation．Comparedwiththepre-operativeMRCP，thediameterofthecommonbileductdidnotchangesignificantlyaftertheprocedure．Onepatientshowedbiliaryleakage，andwagcuredbyconservativetherapy．Twopatientsdevelopedabdominalpainanddistension，whichwagrelievedin48hours．Inonepatient，intermittentabdominalpainwasshownonday5afterthesurgery，andthenjaundiceonday7。boththesymptomswereimprovedonday9．Thepatientsweredischargedfromourhospitalin7tol3dayswithameanof8days．Theyreceivedafollow．upforlto6months。duringwhichnoresidualorrecurrentcalculiwereobserved．ConclusionsModifiedlaparoscopictranscysticcholedochotomvwithprimaryductalclosureisfeasibleforcommonbileductstones．【KeyWords】Primarysuture；Commonbileductstones；Laparoscopy；Cysticduet腹腔镜下胆总管切开取石、T管引流术临床已...
