摘要
目的:探讨经肝圆韧带途径肝门下降法在腹腔镜胆管结石再手术中的安全性及有效性。方法:回顾性分析山东省立第三医院肝胆外科2019年1~9月收治的23例既往有胆道手术史的肝胆管结石或胆总管结石患者临床资料。所有患者均经肝圆韧带途径肝门下降法行腹腔镜下胆道再手术。其中男性10例,女性13例,年龄31~81岁(中位数66岁)。记录患者术中情况、术后恢复情况及出院后随访情况。所有患者均于术后3、6、9及12个月进行电话或门诊随访,记录患者术后恢复及结石复发情况。结果:23例患者中22例完成腹腔镜下再手术,中转开腹1例,中转开腹率为4.3%。手术时间为(116±43)min,术中出血量(32±10)mL,术后住院时间为(8.3±1.8)d,术后均未出现并发症。术后留置T管者均于术后8周行胆道镜检查及取石,1例患者存在结石残留,结石取净率为95.5%。术后随访3~12个月(中位数9个月),无失访患者。所有患者生活质量良好,21例取净结石患者无结石复发。结论:对于复发性胆管结石患者,经肝圆韧带途径肝门下降法行腹腔镜下胆道再手术可快速定位胆总管,手术成功率高,是一种安全可行的方法。
Objective:To investigate the safety and efficiency of hepatic portal descent via ligamentum teres hepatis approach in laparoscopic biliary reoperation.Methods:Retrospective analysis was performed on the clinical data of 23 patients with hepatolithiasis or choledocholithiasis,who had previous history of biliary surgery,admitted to the department of hepatobiliary surgery of Shandong provincial third hospital from January 2019 to September 2019.There were 10 men,13 women,aged 31-81 years(median 66 years).The intraoperative conditions,postoperative recovery and follow-up of the patients were observed.All patients were followed up by telephone or outpatient examination at 3,6,9 and 12 months after the operation to observe the postoperative recovery and the gallstone recurrence rate.Result:In the 23 patients,22 patients successfully underwent laparoscopic biliary reoperation,1 patient transfered to laparotomy,and the conversion laparotomy rate was 4.3%.The operation time and volume of intraoperative blood loss were 116±43 min,32±10 ml respectively.The postoperative hospital stay was 8.3±1.8d and no postoperative complications were occured.The choledochoscopic examinations were underwent in the patients who retained the T-sinus tract at least 6-8 weeks after the common bile duct exploration.1 patient eventually had residual stones,and the gallstone clearance rate was 95.5%.There was no lost to follow-up,and the patients were followed up for 3-12 months(median,9 months)after the operation.All patients had good quality of life,and there was no recurrence of the gallstones in the 21 patients who had removed the calculis completely.Conclusion:For the patients with the recurrent gallstones,hepatic portal descent via ligamentum teres hepatis approach in laparoscopic biliary reoperation can quickly locate the common bile duct and improve the success rate of the operation,which is a safe and feasible method.
作者
梁荔
冯宪光
袁方水
安伟
张锎
LIANG Li;FENG Xian-guang;YUAN Fang-shui;AN Wei;ZHANG Kai(Department of Hepatobiliary Surgery,Shandong Provincial Third Hospital,Cheeloo College of Medicine,Shandong University,Jinan 250012,China)
出处
《中国现代普通外科进展》
CAS
2020年第8期618-620,627,共4页
Chinese Journal of Current Advances in General Surgery
关键词
胆管结石
胆道再手术
肝圆韧带途径
腹腔镜
Cholangiolithiasis
Biliary reoperation
Ligamentum teres hepatis approach
Laparoscopy
