Tang C N, Siu W T, Ha J P Y, Li M K W
Department of Surgery, Pamela Youde Nethersole Eastern Hospital, 3, Lok Man Road, Chai Wan, Hong Kong, People's Republic of China.
Surg Endosc. 2003 Oct;17(10):1590-4. doi: 10.1007/s00464-002-8737-6. Epub 2003 Jul 21.
This article reports the technical aspects of laparoscopic choledochoduodenostomy (LCD) in patients with recurrent pyogenic cholangitis (RPC) and the perioperative results are also evaluated. This is a retrospective review of a prospectively maintained database.
Twelve patients diagnosed to have RPC with the absence of intrahepatic stricture were selected for LCD during the period from 1995 to 2002. The majority of our patients had repeated attacks of cholangitis and had already undergone multiple sessions of endoscopic and operative lithotripsy. The LCD was performed using a five-port approach with the patient lying in the supine position. The stones were first cleared through the longitudinal supraduodenal choledochotomy followed by construction of a side-to-side diamond-shaped anastomosis of at least 15 mm between the bile duct and the first part of the duodenum using 2/0 monocryl in the single-layer method.
During the period from 1995 to 2002, 12 patients with RPC underwent LCD. There were 3 male and 9 female patients with a mean age of 62 (40-77). The median operation time was 137.5 min (90-270) and the median postoperative stay was 7.5 days (5-20). All cases were successful using the laparoscopic approach. Average analgesic requirement post operation was 126 mg (50-200 mg) intramuscular pethidine. There was one postoperative bile leak, and this complication was settled by conservative measures. Upon a mean follow-up of 37.6 months (6-91), there was no recurrent attack of cholangitis or any evidence of sump syndrome in this group of patients.
LCD is a safe and effective drainage procedure for patients with RPC. Complications are uncommon and postoperative results are promising.
本文报道复发性化脓性胆管炎（RPC）患者行腹腔镜胆总管十二指肠吻合术（LCD）的技术要点，并对围手术期结果进行评估。这是一项对前瞻性维护数据库的回顾性研究。
选取1995年至2002年期间诊断为RPC且无肝内狭窄的12例患者行LCD。我们的大多数患者有胆管炎反复发作史，且已接受多次内镜及手术碎石治疗。LCD采用五孔法，患者仰卧位。首先通过十二指肠上段胆总管纵行切开清除结石，然后用2/0单丝可吸收缝线以单层法在胆管与十二指肠第一部之间构建至少15毫米的侧侧菱形吻合。
1995年至2002年期间，12例RPC患者接受了LCD。男性3例，女性9例，平均年龄62岁（40 - 77岁）。中位手术时间为137.5分钟（90 - 270分钟），中位术后住院时间为7.5天（5 - 20天）。所有病例腹腔镜手术均成功。术后平均哌替啶镇痛需求量为126毫克（50 - 200毫克）。术后有1例胆漏，该并发症通过保守措施得以解决。平均随访37.6个月（6 - 91个月），该组患者无胆管炎复发或任何残端综合征迹象。
LCD对RPC患者是一种安全有效的引流手术。并发症少见，术后结果良好。
