【摘要】　目的　 探討腹腔鏡膽總管探查一期縫合的可行性和適應證及臨床價值。　方法　 回顧性分析2007年7月—2010年10月72例膽管結石患者的臨床資料，采用三孔法腹腔鏡膽總管探查術，術中膽道鏡配合膽道手術器械取石，一期縫合膽總管進行治療。　結果　 72例手術均獲成功，無中轉開腹，4例出現術后膽漏，經腹腔引流3~5 d治愈，無嚴重并發癥。術后住院4~7 d（平均4.4 d）。72例均獲隨訪，隨訪時間1~24個月（平均10個月）。術后1個月B型超聲，未發現膽道狹窄及殘余結石。　結論　 腹腔鏡膽總管探查術后一期縫合膽總管，安全、有效、微創效果顯著，是臨床微創治療膽囊結石合并膽管結石的一種理想術式，值得臨床推廣應用。其關鍵是術中取盡結石和把握適應證，同時需要術者熟練掌握膽道鏡技術及腹腔鏡下膽總管切開縫合、打結等技術。
【Abstract】　Objective　 To discuss the feasibility, indications and clinical value of laparoscopic common bile duct exploration with primary suture.　Methods　 We analyzed the clinical data of 72 patients with biliary duct stone treated from July 2007 to October 2010. Three-port laparoscopic common bile duct exploration with primary suture was adopted; choledochoscopy and open bile duct operation instruments were used to take out the stones during the operation; and the common bile duct was treated with primary suture after operation.　Results　 All operations were carried out successfully without any case of conversion to open operation. Bile leakage occurred in four cases and was cured with abdominal drainage tube for three to five days without any severe complications. Postoperative hospitalization time ranged from four to seven days, averaging at 4.4 days. All patients were followed up for one to 24 months (averaging at 10 months). B-mode ultrasonography examination one month after operation showed no biliary tract stricture or residual stone.　Conclusions　 Laparoscopic common bile duct exploration with primary suture is safe, reliable, minimally invasive, more effective, and can be regarded as an ideal operative method for the treatment of cholecystolithiasis combined with biliary duct stone in clinical practices. It is worth popularizing. The key elements for a successful operation lie in completely taking out the stones and having a sound knowledge of indications. Furthermore, surgeons should master the skills in choledochoscopy techniques, laparoscopic incision, suture and ligation.

引用本文： 朱載陽,李英. 腹腔鏡膽總管探查一期縫合的臨床研究. 華西醫學, 2011, 26(6): 893-895. doi: 復制