Hensman C, Crosthwaite G, Cuschieri A
Department of Surgery and Surgical Skills Unit, Ninewells Hospital and Medical School, University of Dundee, Tayside DD1 9SY, Scotland.
Surg Endosc. 1997 Nov;11(11):1106-10. doi: 10.1007/s004649900541.
A purpose-designed transcystic common bile duct (CBD) decompression cannula is described for use as an alternative to T-tube insertion following laparoscopic direct CBD exploration. This permits safe primary closure of the choledochotomy.
Following direct supraduodenal laparoscopic clearance of large common bile duct stones, the biliary decompression cannula is inserted percutaneously inside its peel-away sheet over a guide-wire into the CBD via the cystic duct. When in place, the cannula is secured to the cystic duct by two catgut extracorporeal Roeder knots and the choledochotomy is then closed. The terminal multiperforated S-shaped segment of the Cuschieri biliary decompression cannula prevents postoperative dislodgement.
Transcystic decompression of the extrahepatic biliary tract using the Cuschieri cannula has been used in 12 patients who underwent laparoscopic supraduodenal CBD exploration for large or occluding stones. There was no instance of postoperative dislodgement of the cannula and all patients had effective drainage of the common bile duct (average 300 ml bile per 24 h). The procedure was uncomplicated in all but one patient who developed self-limiting leakage from the CBD suture line in the early postoperative period. The median hospital stay after surgery was 4 days, with a range of 3 to 10 days. The cystic duct decompression cannula was capped and sealed under an occlusive dressing at the time of discharge. Removal of the cannula was carried out without any complications as a day case 11-16 days after surgery.
Transcystic biliary decompression is safe and effective. The experience with is use indicates that compared to T-tube drainage, transcystic decompression may accelerate recovery and reduce the hospital stay in patients following laparoscopic direct exploration of the CBD. Its insertion is less technically demanding than placing a T-tube through the choledochotomy. Transcystic decompression with complete primary closure of the CBD realizes the full benefits of the single-stage management of common bile duct calculi and permits confirmation of complete stone clearance after surgery.
描述了一种专门设计的经胆囊胆总管减压套管，用于在腹腔镜直视下胆总管探查后替代T管置入。这使得胆总管切开术能够安全地一期缝合。
在腹腔镜直视下十二指肠上方清除胆总管大结石后，将胆道减压套管经皮通过其可剥离片套在导丝上，经胆囊管插入胆总管。放置到位后，用两个肠线体外Roeder结将套管固定在胆囊管上，然后关闭胆总管切开处。库施ieri胆道减压套管末端的多孔S形段可防止术后移位。
12例因大结石或阻塞性结石接受腹腔镜十二指肠上方胆总管探查的患者使用了库施ieri套管进行肝外胆道经胆囊减压。套管无术后移位情况，所有患者胆总管引流均有效（平均每24小时胆汁300毫升）。除1例患者术后早期胆总管缝合处出现自限性渗漏外，该手术在所有患者中均无并发症。术后中位住院时间为4天，范围为3至10天。出院时，胆囊管减压套管在封闭敷料下加盖密封。术后11 - 16天作为日间手术取出套管，无任何并发症。
经胆囊胆道减压安全有效。使用经验表明，与T管引流相比，经胆囊减压可加速恢复并缩短腹腔镜直视下胆总管探查患者的住院时间。其插入技术要求低于通过胆总管切开处放置T管。经胆囊减压并完全一期缝合胆总管可实现胆总管结石单阶段管理的全部益处，并允许术后确认结石完全清除。
