摘要
目的探讨腹腔镜再次胆道手术治疗胆总管结石的手术技巧。方法回顾性分析我院2011年1月~2015年12月54例既往有胆道手术史的胆总管结石行腹腔镜下胆总管切开取石的临床资料,术中通过穿刺孔选择、肝脏面显露、胆总管显露确认途径,行胆道镜取石T管引流术或胆总管一期缝合术。结果 52例腹腔镜手术均成功,中转开腹2例。术中出血量40~150 ml,平均70 ml;手术时间75~180 min,平均120 min;术后胃肠功能恢复时间24~48 h,(27±13)h。术中十二指肠穿孔性损伤1例,术后发生胆漏2例,残余结石2例,分别采用腹腔镜下缝合修补、延长拔腹腔引流管时间、经窦道胆道镜取石等方法处理。术后住院时间6~9 d,(7.0±1.5)d。54例随访3~24个月,平均14.8月,均恢复良好,无胆道狭窄、结石复发。结论掌握熟练的腹腔镜手术方法和分离术区粘连技巧,腹腔镜再次胆道手术治疗胆总管结石是安全可行的。
5 Objective To explore the technique of laparoscopic reoperation in the treatment of common bile duct stones.Methods A retrospective analysis of the clinical data of 54 cases of common bile duct stones undergoing laparoscopic common bile duct stone surgery in our hospital from January 2011 to December 2015 was conducted.Through the choice of puncture hole, the exposure of the liver surface and the confirmation of the common bile duct, T-tube drainage and primary suture of common bile duct were carried out for the treatment of bile duct stone.Results The laparoscopic operations were successful in 52 cases, while conversions to open surgery were required in 2 cases.During the operation, the amount of bleeding was about 40-150 ml （average, 70 ml）, the operation time was 75-180 min （average, 120 min）, and the postoperative gastrointestinal function recovery time was 24-48 h （average, 27±13 h）.There were 1 case of duodenal perforation injury, 2 cases of bile leakage, and 2 cases of residual stones after operation, which were cured with laparoscopic repair, prolonged drainage time, and choledochoscope treatment via abdominal sinus.Postoperative hospital stay was 6-9 d （average, 7±1.5 d）.A total of 54 cases were followed up for 3-24 months （mean, 14.8 months）.All the patients recovered well, without bile duct stricture or stone recurrence.Conclusion As long as the application of skilled laparoscopic surgery methods and separation of surgical area skills, laparoscopic bile duct surgery for the treatment of common bile duct stones is safe and feasible.Department of General Surgery, The Sixth People9 s Hospital of Luoyang Ci ty, Luoyang 471003 , China
出处
《中国微创外科杂志》
CSCD
北大核心
2017年第7期615-617,共3页
Chinese Journal of Minimally Invasive Surgery
关键词
腹腔镜
再次手术
胆总管结石
Laparoscopy
Reoperation
Common bile duct stones
