腹腔镜下胆道探查取石T管引流优化术的临床应用

doi:10.3877/cma.j.issn.1674-3946.2021.02.025

中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (02) : 211 -214. doi: 10.3877/cma.j.issn.1674-3946.2021.02.025

所属专题：文献；

论著

腹腔镜下胆道探查取石T管引流优化术的临床应用

张乾¹, 肖瑞², 杨景瑞¹, 周江¹, 王家兴¹, 刘少杰¹, 张小冬¹, 任建军¹^,^†(

)

^1. 010050　呼和浩特市，内蒙古医科大学附属医院肝胆外科
^2. 010059　呼和浩特市，内蒙古医科大学分子病理学重点实验室

收稿日期:2020-07-08 出版日期:2021-04-26
通信作者: 任建军

The clinical application of optimized laparoscopic choledocholithotomy T-tube drainage

Qian Zhang¹, Rui Xiao², Jingrui Yang¹, Jiang Zhou¹, Jiaxing Wang¹, Shaojie Liu¹, Xiaodong Zhang¹, Jianjun Ren¹^,^†()

^1. 010050, Hohhot, Inner Mongolia, Department of Hepatobiliary Surgery, The Affiliated of Inner Mongolia Medical University
^2. 010059, Hohhot, Inner Mongolia, Key Laboratory of Molecular Pathology of Inner Mongolia Medical University

Received:2020-07-08 Published:2021-04-26
Corresponding author: Jianjun Ren
Supported by:
Research and Practice Project of Graduate Education and Teaching Reform in the Department of Education of Inner Mongolia Autonomous Region in 2018(YJG20181013202); Project of Natural Science Foundation of Inner Mongolia Autonomous Region(2017MS0834); Science and Technology Plan Project of Inner Mongolia Autonomous Region(201702113)

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引用本文：

张乾, 肖瑞, 杨景瑞, 周江, 王家兴, 刘少杰, 张小冬, 任建军. 腹腔镜下胆道探查取石T管引流优化术的临床应用[J/OL]. 中华普外科手术学杂志(电子版), 2021, 15(02): 211-214.

Qian Zhang, Rui Xiao, Jingrui Yang, Jiang Zhou, Jiaxing Wang, Shaojie Liu, Xiaodong Zhang, Jianjun Ren. The clinical application of optimized laparoscopic choledocholithotomy T-tube drainage[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(02): 211-214.

目的

(1)探讨腹腔镜下胆道探查取石T管引流优化术治疗胆总管结石的可行性及安全性。

方法

(2)回顾性分析2018年2月至2020年4月内蒙古医科大学附属医院收治的54例胆总管结石患者行腹腔镜下胆道探查取石T管引流优化术的临床资料。

结果

54例患者均顺利完成优化手术，手术时间为(152.4±51.2) min，术后拔除肝下引流管时间为(4.3±1.4) d，术后住院时间为(5.8±2.0) d。1例患者术后出现胆漏，发生率为1.9%。1例患者术后6～8周行T管造影有结石残留，发生率为1.9%。术后随访患者51例，无结石再发和胆管狭窄发生。

结论

腹腔镜下胆道探查取石T管引流优化术对于治疗胆总管结石是安全有效的，优化的手术步骤以及新颖的胆总管缝合方法可保证手术高效、高质量的完成以及降低术后并发症。

关键词: 胆总管结石, 胆囊结石病, 腹腔镜, 引流术, T管引流, 手术方法

Objective

To evaluate the feasibility and safety of optimized laparoscopic choledocholithotomy T-tube drainage (LCHTD) in the treatment of common bile duct stones.

Methods

Retrospective analysis of clinical data from February 2018 to April 2020 for 54 patients with choledocholithiasis and gallstones who underwent optimized laparoscopic choledocholithotomy T-tube drainage.

Result

Optimized laparoscopic choledocholithotomy T-tube drainage was completed successfully for 54 patients. The operative time was (152.4±51.2) min, the postoperative time of extraction of subhepatic drainage tube (4.3±1.4) d, the postoperative hospitalization time was (5.8±2.0) d. One patient had bile leakage after operation, with an incidence rate of 1.9%, One patient had residual stones after T-tube angiography 6-8 weeks postoperatively, with an incidence of 1.9%. Postoperative follow-up of 51 patients showed no calculus regeneration or bile stricture occurred.

Conclusions

Optimized laparoscopic choledocholithotomy T-tube drainage is safe and effective for the treatment of choledocholithiasis. Optimized surgical procedures and novel common bile duct suture methods can ensure efficient and high-quality completion of the operation and reduce postoperative complications.

Key words: Choledocholithiasis, Cholecystolithiasis, Laparoscopes, Drainage, T-tube Drainage, Surgical methods

图1 腹腔镜下胆总管探查取石T管引流优化术术中操作图[注：A.处理胆囊三角；B.电针切开胆管；C.胆道探查取石；D.T管远端用线结扎E.胆管上角缝合；F.胆管缝合第二针；G.胆管下角缝合；H.第二、三针一并打结；I.将大网膜拉向T管周围；]

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