摘要
目的 总结腹腔镜下胆总管切开联合胆道镜取石术治疗血吸虫性肝硬化合并胆总管结石患者的手术经验。方法 回顾性分析2012年9月至2015年9月期间我院收治的45例肝功能分级Child-Pugh A、B级的血吸虫性肝硬化合并胆总管结石患者的临床资料,其中有25例行传统开腹胆总管切开取石术（传统开腹组）,20例行腹腔镜下胆总管切开联合胆道镜取石术（腹腔镜组）。结果 45例患者均治愈出院。有2例患者因腹腔镜术中出血而中转剖腹手术,传统开腹组和腹腔镜组患者的手术时间、术中出血量及术后住院时间比较差异均无统计学意义（P〉0.05）。传统开腹组术后共发生并发症3例（12.0%）,其中肺部感染2例,切口感染1例,无胆汁漏发生;而腹腔镜组共发生并发症2例（10.0%）,其中胆汁漏1例（为A级胆汁漏,仅保持腹腔引流管引流通畅而治愈）,肺部感染1例,无切口感染发生。2组患者术后均未发生胆总管残余结石,2组术后总并发症发生率比较差异无统计学意义（χ~2=1.0,P=0.61）。结论 血吸虫性肝硬化合并胆总管结石患者腹腔镜手术操作难度较大,但仍安全、可行。正确的围手术期处理、精细的腹腔镜及胆道镜操作是手术成功的关键。
Objective To summarize experience of laparoscopy combined with choledochoscopy common bile duct exploration for patients with schistosomiasis liver cirrhosis with common bile duct stones. Method The clinical data of 45 patients with schistosomiasis liver cirrhosis combined with common bile duct stones （liver function Child-Pugh grade A and B） admitted in this hospital from September 2012 to September 2015 were analyzed retrospectively. Results Twenty cases were successfully treated by laparoscopy combined with choledochoscopy （laparoscope group）, 25 cases were treated by conventional open common bile duct exploration （laparotomy group）. Two cases were converted to laparotomy due to bleeding during laparoscopic operation. The mean operation time, intraoperative bleeding, postopera- tive hospitalization time, and postoperative total complications rate had no significant differences between these two groups （P〉0.05）. There were 2 cases of pulmonary infection and 1 case of incision infection in the laparoscope group, and 1 case of grade A bile leakage and 1 case of pulmonary infection in the laparotomy group, there was no common bile duct stone residual in these two groups. Conclusions Although laparoscopic surgery is more difficult for schistosomiasis liver cirrhosis combined with common bile duct stones patients, it is safe and feasible. Appropriate perioperative management and precise laparoscopic and choledochoscopic operation are key to success of operation.
出处
《中国普外基础与临床杂志》
CAS
2016年第11期1362-1365,共4页
Chinese Journal of Bases and Clinics In General Surgery
关键词
胆总管结石
血吸虫性肝硬化
微创治疗
Common bile duct stone
Schistosomiasis liver cirrhosis
Minimally invasive treatment
