腹腔镜联合硬性胆道镜胆总管切开取石一期缝合53例报告.pdf

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1、J实用临床医药零志20l4年第18卷第7期·64·ournalofC1inicalMedicineinPractice⋯。⋯⋯⋯⋯腹腔镜联合硬性胆道镜胆总管切开取石一期缝合53例报告李嘉兴，郭永学，王金重，莫奇霏，钟锋(广东省江门市人民医院普外科，广东江门，529000)摘要：目的探讨腹腔镜联合硬性胆道镜行胆总管切开取石一期缝合可行性，以及手术技巧。方法回顾分析2011年3月一2013年11月本院53例患者行腹腔镜联合硬性胆道镜胆总管切开取石一期缝合术的临床资料。结果53例手术均获成功，无中转开腹。手术时间90～168min，平均112rain，术后恢

2、复顺利，住院6～9d，平均6．6d。术后无再出血、腹腔感染、胆漏、胆管狭窄、胆道结石残留等并发症发生。结论严格选择胆总管结石病例行腹腔镜联合硬性胆道镜镜胆总管切开取石一期缝合术是可行的，具有创伤小、康复快、住院时间短等优点，值得在有条件的医院推广应用。关键词：胆总管结石；胆总管切开取石术；腹腔镜；硬性胆道镜；胆总管一期缝合中图分类号：R657．4文献标志码：A文章编号：1672—2353(2014)07—064—02130I：10．7619／jcmp．201407019Effectofprimarysuturebyrigidch0led0ch0sc0p

3、ecombinedwithlaparoscopiccommonbileductexploration：areportof53casesLIJiaxing，GUOYongxue，WANGJinzhong，MOQifei，ZHONGFeng(DepartmentofGeneralSurgery，JiangmenPeopleSHospital，Jiangmen，Guangdong，529000)ABSTRACT：ObjectiveToexplorethefeasibilityandsurgicaltechniquesofprimarysuturebyrigi

4、dcholedochoscopecombinedwith1aparoscopiccommonbileductexploration．MethodsClinicalmaterialsof53patientswithprimarysuturebyrigidcholedochoscopecombinedwithlaparoscopiccorilinonbileductexplorationwereanalyzedretrospectively．Results53patientscompletedopera—tionssuccessfully．Theopera

5、tingtimewas90to168minutes．withaveragedurationof112rain—utes．Postoperativehospitalstaywas6to9days，withanaveragelengthof6．6days．Nopostoper—ativecomplicationssuchasbleeding，abdominalinfection，bileleakage，bileductstrictureandresid—ualbiliarystoneswereobserved．ConclusionUnderthepremi

6、seofstrictlyselectingcaseswithcomlTlonbileductstones，rigidcholedochoscopecombinedwithIaparoscopiccommonbileductexplo—rationforprimarysutureisafeasiblemethod，ithastheadvantagesof1esstrauma，fastrecoveryandshorthospitalstay，SOitisworthyofpopularization．KEYⅥ：comInoDbileductstones；ch

7、oledocholithotomy；laparoscopy；rigidcholedo—choscope；laparoscopiccommonbileductexplorationandprimarysuture本院自2011年3月一2013年11月为53例55．6岁。全部病例术前均行肝胆胰脾B超和上患者行腹腔镜联合硬性胆道镜胆总管切开取石一腹部CT检查及磁共振胰胆管造影(MRCP)或逆期缝合术，效果满意，报告如下。行胰胆管造影(ERCP)，其中胆囊结石合并胆总管结石35例，单纯胆总管结石18例。患者胆总1资料与方法管上段直径均≥10n'tlTl，无合并

8、肝内胆管结石、1．1临床资料胆道狭窄、Mirizzi综合征及肿瘤患者。发热2353例中男19例