摘要
目的探讨日间行腹腔镜胆囊切除及经胆囊管胆道探查取石术的可行性和安全性。方法回顾性分析2015年1月—2018年1月于首都医科大学附属北京友谊医院行日间腹腔镜胆囊切除及术中经胆囊管胆道探查取石术的69例患者的病例资料，分析其术前症状及体征、实验室检查、影像学检查等诊断数据，术中探查结果、手术时间等治疗数据，术后离院时间、整体花费，以及术后3d电话随访、术后7d和术后3个月门诊随访结果。结果人组的69例患者中，21．7％（15／69）的患者术前根据病史评估具有胆道探查指征，33．3％（23／69）的患者为单纯实验室检查异常具备胆道探查指征，均有谷氨酰转肽酶水平明显升高，5．8％（4／69）的患者为单纯影像学检查异常具备胆道探查指征。胆道探查24．6％（17／69）的患者可见结石，10．1％（7／69）的患者可见胆道内泥沙样结石及分泌物，探查阴性为65．2％（45／69）。手术时间41—169min，平均111min。所有患者均未留置腹腔引流管。1例患者因术后恶心、呕吐转住院观察治疗并于术后第1天出院；其余患者术后1．4～8．3h出院，平均2．8h；住院费用7820—16285元，平均13619元。术后3d内电话随访无严重并发症，术后7d复查时因低热发现1例患者胆囊窝积液，经抗感染治疗好转。术后3个月复查者均无胆管残余结石。结论运用加速康复外科理论，腹腔镜胆囊切除及术中经胆囊管胆道探查术在经验丰富的中心可以以Et间手术途径完成；目前尚无有效方法预测胆道探查结果，经严格筛选病例能够保证其安全性。
Objective To investigate the safety and feasibility of laparoscopic common bile duct exploration through cystic duct while cholecystectomy by means of day surgery. Methods The data of 69 patients who received day surgery of laparoscopic cholecystectomy and intraoperative transcystic biliary duct exploration from January 2015 to January 2018 in Beijing Friendship Hospital, Capital Medical University were analyzed. Preoperative symptoms and signs, laboratory examinations, imaging examinations, intraoperative exploration results, operation time, postoperative time, hospitalization expenses, as well as short time follow-up data were analyzed retrospectively. Results Sixty-nine cases of day surgery were inrolled. 21.7% （15/69） were indicated in bile duct exploration according to medical history, and 33.3% （23/69） simply because of abnormal blood examination which all showed elevated gamma-glutamyl transferase and 5.8% （4/69） only for positive imaging results. In the surgery, 24.6% （17/69） found bile duct stones, and 10.1% （7/69） found sand-like stones or floccule in the biliary tract exploration, while negative exploration in 65.2% （45/69）. The operation time ranged from 41 to 169 （ median 111 ） minutes. No patient placed drainage tube in the surgery. Only 1 patient discharged at the first day after surgery because that nausea and vomiting led to a conversion to be hospitalized. The other patients discharged from the hospital in 1.4 to 8.3 （median 2.8） hours after the surgery; hospitalization costs 7 820 to 16 285 （Median 13 619） yuan. Telephone follow-up found no serious complications 3 days after operation, and 1 patient complainted low grade fever 7 days after discharge due to gallbladder fossa fluid was cured by antibiotics. No residual stone was detected by ultrasound examination 3-month after surgery in follow-up cases. Conclusions As a practice of enhanced recovery after surgery concept, laparoseopie cholecystectomy and intraoperative transcystic bile duct exploration by mean
作者
吴鸿伟
周晓娜
郭伟
金岚
汪栋
刘军
张忠涛
Wu Hongwei;Zhou Xiaona;Guo Wei;Jin Lan;Wang Dong;Liu Jun;Zhang Zhongtao(Department of General Surgery, Be~l＇ing Friendship Hospital, Capital Medical Universit;National Clinical Research Center for Digestive Disease, Beijing 100050, Chin)
出处
《国际外科学杂志》
2018年第6期373-377,共5页
International Journal of Surgery
基金
北京市医院管理局临床医学发展专项（ZYLX201504）
国家科技支撑计划课题（2015BA113809）
关键词
胆囊切除术
腹腔镜
外科手术
日间手术
经胆囊管胆道探查术
Cholecystectomy
laparoscopic
Surgical procedures
operative
Day surgery
Laparoscopic transcystic bile duct exploration
