摘要
目的 探讨腹腔镜胆管探查术中常见问题的处理方法 .方法 对 71例腹腔镜胆管探查患者 ,比较其胆管切开方法的差别 ,观察术中胆道造影的价值 ,分析Ⅰ期缝合胆总管的结果 .结果 71例中 70例取出结石 ,全部病人痊愈 .胆管壁直接尖刀切开、电凝胆管壁上的小血管后以专用尖刀或弯剪刀切开胆总管、从胆管穿刺针眼处直接电钩钩开部分胆管壁、超声刀分离胆管前壁后从穿刺针眼处切开胆管等四种胆管切开方法以后二种方法最为方便快捷 .行术中胆管造影发现胆管结石 11例 ,全部为术前超声检查及术中观察胆管直径在 8～ 11mm者 .9例I期缝合胆总管 ,发生胆漏 2例 (2 2 .2 % ) ,明显高于放置T管组 .结论 腹腔镜胆管探查术是安全、有效的手术方法 ,病人痛苦小、恢复快 .电钩直接钩开胆管壁是最为方便快捷的胆管切开方法 ;术中胆管造影应选择性使用 ;直接缝合胆总管胆漏发生率较高。
Objective To study the problems and management in laparoscopic common bile duct (CBD) exploration. Methods The incisioned methods of CBD were compared and value of choledochography in operation were observed. The outcome of primary suture were analysed. Results The stones were extracted in 70 0f 71 cases and all recover. The measure hook electrode carve in the front wall of CBD was best in four technique.11 cases were found by choledochography in operation. 2 cases had fistula and were cured by means of conservative treatment in 11 cases with primary suture. Conclusions Laparoscopic common bile duct exploration is safe and efficient. The hook electrode carve in the front wall of CBD is convenient and shortcut. The choledochography in operation should be used selectively.Primary suture would be used in control because of high morbidity of bile fistula.
出处
《现代临床医学生物工程学杂志》
2002年第5期353-354,共2页
Journal of Modern Clinical Medical Bioengineering
