膽總管探查術后一期縫合的臨床經驗及適應證探討_《中國普外基礎與臨床雜志》

作者：

倪平志 , 劉雋 , 湯可立 , 程建華 , 羅丹

貴州省人民醫院肝膽胰外科(貴州貴陽 550002);

關鍵詞：

膽總管探查膽囊結石一期縫合漏膽適應證

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目的總結膽總管探查術后一期縫合的經驗，探討其適應證以及評價其臨床效果。方法回顧性分析2006年2月至2010年6月期間137例行膽總管一期縫合手術患者的臨床資料。結果所有患者手術均成功，手術時間65~213 min(平均129 min)，出血量50~350 ml(平均148 ml)。 124例(90.5%)患者術后均未發生并發癥，術后1周內順利出院; 其余13例(9.5%)患者術后出現漏膽，其中10例(18.5%,10/54)為技術早期(2007年10月以前)開展病例，3例(3.6%，3/83)為開展后期病例，均未作特殊處理，于術后3周內好轉出院。 113例(82.5%)患者獲得隨訪，經過2~54個月隨訪(中位隨訪時間14個月)，無一例患者出現膽管殘石、膽總管結石復發和膽管狹窄。結論在嚴格掌握手術適應證和具備熟練的手術技巧前提下，膽總管探查術后一期縫合是安全、有效的。

引用本文： 倪平志,劉雋,湯可立,程建華,羅丹. 膽總管探查術后一期縫合的臨床經驗及適應證探討. 中國普外基礎與臨床雜志, 2011, 18(3): 320-323. doi: 復制

1.	Zhang WJ, Xu GF, Wu GZ, et al. Laparoscopic exploration of common bile duct with primary closure versus Ttube drainage: a randomized clinical trial [J]. J Surg Res, 2009, 157(1): e1e5.
2.	Ahmed I, Pradhan C, Beckingham IJ, et al. Is a Ttube necessary after common bile duct exploration? [J]. World J Surg, 2008, 32(7): 14851488.
3.	Ambreen M, Shaikh AR, Jamal A, et al. Primary closure versus Ttube drainage after open choledochotomy [J]. Asian J Surg, 2009, 32(1): 2125.
4.	孫利國, 劉小敏. 膽總管切開取石Ⅰ期縫合64例報道 [J]. 中國普外基礎與臨床雜志, 2007, 14(1): 109.
5.	田明國, 楊峻峰, 胡偉, 等. 膽總管探查切口一期縫合內支架引流術 [J]. 中國普通外科雜志, 2007, 16(2): 114116.
6.	周蒙滔, 孫洪偉, 金約朋, 等. 膽總管一期縫合術在膽道外科的應用 [J]. 肝膽胰外科雜志, 2009, 21(1): 3133.
7.	Tan KK, Shelat VG, Liau KH, et al. Laparoscopic common bile duct exploration: our first 50 cases [J]. Ann Acad Med Singapore, 2010, 39(2): 136142.
8.	Pawa N, Tutton MG. Primary common bile duct closure is safe following emergency and elective exploration [J]. World J Surg, 2009, 33(8): 1779.
9.	Zhu QD, Tao CL, Zhou MT, et al. Primary closure versus Ttube drainage after common bile duct exploration for choledocholithiasis [J]. Langenbecks Arch Surg, 2010, 14(5):844848.
10.	王毅本, 曾小兵, 吳馳, 等. 膽總管探查后一期縫合膽汁漏的臨床分析 [J]. 中國普外基礎與臨床雜志, 2005, 12(4): 351352, 360.
11.	許龍堂, 鄭樟棟, 陳凱, 等. 膽總管探查后一期縫合的臨床問題探討 [J]. 中華肝膽外科雜志, 1998, 4(1): 5557.
12.	蔡珍福, 王堅, 周玉坤, 等. 膽總管切開纖維膽道鏡探查一期縫合695例分析 [J]. 肝膽胰外科雜志, 2004, 16(2): 110111.
13.	張光全, 吳先麟, 廖忠, 等. 膽總管一期縫合術(附350例報告) [J]. 肝膽胰外科雜志, 2008, 20(6): 420422.
14.	王志剛, 黃漢濤, 張英明, 等. 膽總管探查后一期縫合術中置鼻膽管引流術 [J]. 肝膽外科雜志, 2007, 15(2): 122124.
15.	裘豐, 王韋華, 嚴志龍, 等. 腹腔鏡下一期切開縫合膽總管治療膽總管結石 [J]. 肝膽胰外科雜志, 2004, 16(4): 283284.
16.	Alhamdani A, Mahmud S, Jameel M, et al. Primary closure of choledochotomy after emergency laparoscopic common bile duct exploration [J]. Surg Endosc, 2008, 22(10): 21902195.
17.	Yamazaki M, Yasuda H, Tsukamoto S, et al. Primary closure of the common bile duct in open laparotomy for common bile duct stones [J]. J Hepatobiliary Pancreat Surg, 2006, 13(5): 398402.
18.	Wani MA, Chowdri NA, Naqash SH, et al. Primary closure of the common duct over endonasobiliary drainage tubes [J]. World J Surg, 2005, 29(7): 865868.
19.	Ha JP, Tang CN, Siu WT, et al. Primary closure versus Ttube drainage after laparoscopic choledochotomy for common bile duct stones [J]. Hepatogastroenterology, 2004, 51(60): 16051608.
20.	Leida Z, Ping B, Shuguang W, et al. A randomized comparison of primary closure and Ttube drainage of the common bile duct after laparoscopic choledochotomy [J]. Surg Endosc, 2008, 22(7): 15951600.
21.	Huang SM, Yao CC, Cheng YW, et al. Laparoscopic primary closure of common bile duct combined with percutaneous cholangiographic drainage for treating choledocholithiasis [J]. Am Surg, 2010, 76(5): 517521.
22.	Ivanov D, Milosevi ＇c P. Primary closure of the common bile duct in the treatment of choledocholithiasis [J]. Med Pregl, 2010, 63(1): 99103.
23.	Tekin A, Ogetman Z. Laparoscopic exploration of the common bile duct with a rigid scope in patients with problematic choledocholithiasis [J]. World J Surg, 2010, 34(8): 18941899.
24.	Li LB, Cai XJ, Mou YP, et al. Reoperation of biliary tract by laparoscopy: experiences with 39 cases [J]. World J Gastroenterol, 2008, 14(19): 30813084.
25.	Jameel M, Darmas B, Baker AL. Trend towards primary closure following laparoscopic exploration of the common bile duct [J]. Ann R Coll Surg Engl, 2008, 90(1): 2935.
26.	Taylor CJ, Kong J, Ghusn M, et al. Laparoscopic bile duct exploration: results of 160 consecutive cases with 2year followup [J]. ANZ J Surg, 2007, 77(6): 440445.

1. Zhang WJ, Xu GF, Wu GZ, et al. Laparoscopic exploration of common bile duct with primary closure versus Ttube drainage: a randomized clinical trial [J]. J Surg Res, 2009, 157(1): e1e5.
2. Ahmed I, Pradhan C, Beckingham IJ, et al. Is a Ttube necessary after common bile duct exploration? [J]. World J Surg, 2008, 32(7): 14851488.
3. Ambreen M, Shaikh AR, Jamal A, et al. Primary closure versus Ttube drainage after open choledochotomy [J]. Asian J Surg, 2009, 32(1): 2125.
4. 孫利國, 劉小敏. 膽總管切開取石Ⅰ期縫合64例報道 [J]. 中國普外基礎與臨床雜志, 2007, 14(1): 109.
5. 田明國, 楊峻峰, 胡偉, 等. 膽總管探查切口一期縫合內支架引流術 [J]. 中國普通外科雜志, 2007, 16(2): 114116.
6. 周蒙滔, 孫洪偉, 金約朋, 等. 膽總管一期縫合術在膽道外科的應用 [J]. 肝膽胰外科雜志, 2009, 21(1): 3133.
7. Tan KK, Shelat VG, Liau KH, et al. Laparoscopic common bile duct exploration: our first 50 cases [J]. Ann Acad Med Singapore, 2010, 39(2): 136142.
8. Pawa N, Tutton MG. Primary common bile duct closure is safe following emergency and elective exploration [J]. World J Surg, 2009, 33(8): 1779.
9. Zhu QD, Tao CL, Zhou MT, et al. Primary closure versus Ttube drainage after common bile duct exploration for choledocholithiasis [J]. Langenbecks Arch Surg, 2010, 14(5):844848.
10. 王毅本, 曾小兵, 吳馳, 等. 膽總管探查后一期縫合膽汁漏的臨床分析 [J]. 中國普外基礎與臨床雜志, 2005, 12(4): 351352, 360.
11. 許龍堂, 鄭樟棟, 陳凱, 等. 膽總管探查后一期縫合的臨床問題探討 [J]. 中華肝膽外科雜志, 1998, 4(1): 5557.
12. 蔡珍福, 王堅, 周玉坤, 等. 膽總管切開纖維膽道鏡探查一期縫合695例分析 [J]. 肝膽胰外科雜志, 2004, 16(2): 110111.
13. 張光全, 吳先麟, 廖忠, 等. 膽總管一期縫合術(附350例報告) [J]. 肝膽胰外科雜志, 2008, 20(6): 420422.
14. 王志剛, 黃漢濤, 張英明, 等. 膽總管探查后一期縫合術中置鼻膽管引流術 [J]. 肝膽外科雜志, 2007, 15(2): 122124.
15. 裘豐, 王韋華, 嚴志龍, 等. 腹腔鏡下一期切開縫合膽總管治療膽總管結石 [J]. 肝膽胰外科雜志, 2004, 16(4): 283284.
16. Alhamdani A, Mahmud S, Jameel M, et al. Primary closure of choledochotomy after emergency laparoscopic common bile duct exploration [J]. Surg Endosc, 2008, 22(10): 21902195.
17. Yamazaki M, Yasuda H, Tsukamoto S, et al. Primary closure of the common bile duct in open laparotomy for common bile duct stones [J]. J Hepatobiliary Pancreat Surg, 2006, 13(5): 398402.
18. Wani MA, Chowdri NA, Naqash SH, et al. Primary closure of the common duct over endonasobiliary drainage tubes [J]. World J Surg, 2005, 29(7): 865868.
19. Ha JP, Tang CN, Siu WT, et al. Primary closure versus Ttube drainage after laparoscopic choledochotomy for common bile duct stones [J]. Hepatogastroenterology, 2004, 51(60): 16051608.
20. Leida Z, Ping B, Shuguang W, et al. A randomized comparison of primary closure and Ttube drainage of the common bile duct after laparoscopic choledochotomy [J]. Surg Endosc, 2008, 22(7): 15951600.
21. Huang SM, Yao CC, Cheng YW, et al. Laparoscopic primary closure of common bile duct combined with percutaneous cholangiographic drainage for treating choledocholithiasis [J]. Am Surg, 2010, 76(5): 517521.
22. Ivanov D, Milosevi ＇c P. Primary closure of the common bile duct in the treatment of choledocholithiasis [J]. Med Pregl, 2010, 63(1): 99103.
23. Tekin A, Ogetman Z. Laparoscopic exploration of the common bile duct with a rigid scope in patients with problematic choledocholithiasis [J]. World J Surg, 2010, 34(8): 18941899.
24. Li LB, Cai XJ, Mou YP, et al. Reoperation of biliary tract by laparoscopy: experiences with 39 cases [J]. World J Gastroenterol, 2008, 14(19): 30813084.
25. Jameel M, Darmas B, Baker AL. Trend towards primary closure following laparoscopic exploration of the common bile duct [J]. Ann R Coll Surg Engl, 2008, 90(1): 2935.
26. Taylor CJ, Kong J, Ghusn M, et al. Laparoscopic bile duct exploration: results of 160 consecutive cases with 2year followup [J]. ANZ J Surg, 2007, 77(6): 440445.

《中國普外基礎與臨床雜志》

膽總管探查術后一期縫合的臨床經驗及適應證探討

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《中國普外基礎與臨床雜志》

膽總管探查術后一期縫合的臨床經驗及適應證探討

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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