摘要
目的探讨腹腔镜下纤维胆道镜联合钬激光治疗胆总管结石中并发症的发生情况及防治措施。方法采用回顾性横断面研究方法。收集2016年1至2018年12月我院收治的32例行腹腔镜下纤维胆道镜联合钬激光取石术的胆总管结石(合并或不合并胆囊结石)患者的临床资料。观察指标:(1)术中情况:手术方式、手术时间、术中出血量和术中并发症情况。(2)术后情况:首次通气时间、住院时间和术后并发症发生情况。(3)随访情况:术后1个月行T管造影,拔除T型管后门诊随访6个月,随访内容包括有无腹痛、发热、黄疸等症状,并通过B超或MRCP检查有无胆道结石复发。结果32例患者均成功实施了腹腔镜下纤维胆道镜联合钬激光取石术或腹腔镜下胆囊切除+纤维胆道镜联合钬激光取石术。总体手术时间为(105.9±21.3)min,出血量为(35.9±11.3)mL。术中副损伤1例,胆道出血1例。术后情况:32例患者术后平均首次通气时间为(22.4±5.7)h,平均住院时间为(11.5±2.3)d,32例患者中,5例并发症分别为1例胆漏、1例胆道出血、2例腹腔感染和1例残余结石。结论腹腔镜下胆道镜联合钬激光治疗胆总管结石安全可行,正确辨认关键解剖标志、熟练的腹腔镜下胆道镜取石和镜下缝合技术及钬激光的正确操作是保障手术成功,避免或减少并发症发生的关键所在。
Objective To explore conditions and prevention of the complications of laparoscopic choledochoscopy combined with holmium laser in the treatment of incarcerated common bile duct stones.Methods The retrospective cross-sectional study was conducted.The clinical data of 32 patients with common bile duct stone (combined or non-combined gallstones ) who were treated with laparoscopic choledochoscopy combined with holmium laser in our Hospital form January 2016 to December 2018 were collected.Observation indicators:(1) intraoperative situations:surgical procedure,operation time,blood loss and complications during the operation.(2) postoperative situations:time to anal exsufflation,duration of hospital stay and postoperative complications.(3) follow-up: T tube radiography was performed for one month after operation,and patients had been followed for six months in the outpatient after T tube removal.Follow-up included abdominal pain,fever,jaundice and residual common bile duct stones which were examined by B-ultrasound or MRCP.Results The laparoscopic choledochoscopy combined with holmium laser in the treatment of incarcerated common bile duct stones was successfully performed in 32 patients.The total operation time was (105.9 ± 21.3)minutes and the amount of bleeding was (35.9 ± 11.3)milliliter.Two complications occurred during the operations,including one side injury and one biliary hemorrhage.Time to anal exsufflation and hospital stay were (22.4 ± 5.7) hours and(11.5 ± 2.3) days.Five complications occurred after operations,including one bile leakage,one hemobilia,two infections and one bile duct stone remnant.Conclusion Laparoscopic choledochoscopy combined with holmium laser in the treatment of incarcerated common bile duct stones are safe.Correct identification of anatomical markers,laparoscopic suture technique,skilled laparoscopic and holmium laser techniques can ensure successful operation and avoid or reduce complications.
作者
刘玉海
张俊松
LIU Yu-hai;ZHANG Jun-song(Department of General Surgery,The Third Affiliated Hospitalof AnHui Medical University,HeFei Binhu Hospital,Hefei 230601,China)
出处
《肝胆外科杂志》
2019年第3期207-210,共4页
Journal of Hepatobiliary Surgery
关键词
胆总管结石
钬激光
腹腔镜
并发症
common bile duct stone
holmium laser
laparoscope
complication
