摘要
目的探讨腹腔镜下再次胆道手术治疗肝外胆道结石的临床经验及价值。方法选取本院2012年1月至2019年9月收治的既往有胆道手术史的肝外胆管结石患者60例,随机分为观察组与对照组,每组30例。观察组采用腹腔镜胆总管探查取石术,对照组采用开腹胆总管探查取石术,观察比较两组的手术时间、术中副损伤、术中出血量、术后肛门排气时间、术后住院时间、住院费用、术后3 d肝功能(白蛋白、总胆红素)及术后并发症发生情况(胆漏、切口感染)、结石残留率。结果观察组28例腹腔镜再次手术成功,2例中转开腹,观察组在剔除2例中转开腹患者后,手术时间、术中副损伤、住院费用、术后胆瘘发生率、结石残留率与对照组比较差异无统计学意义。观察组术后肝功能、切口感染率、肠功能恢复、术后住院时间优于对照组(P<0.05)。结论运用合理的腹腔镜下分离粘连的策略及技巧,腹腔镜应用于再次胆道手术治疗肝外胆管结石安全可行,比传统开腹手术具有较大微创优势,应作为肝外胆管结石再次手术的首选方式,值得临床推广应用。
Objective To explore the clinical experience and value of laparoscopic surgery in the treatment of extrahepatic biliary stones.Methods A total of 60 patients with extrahepatic bile duct stones with a history of biliary tract surgery in our hospital from January 2012 to December 2019 were selected.They were randomly divided into observation group and control group,with 30 cases in each group.Laparoscopic choledocholithotomy was used in the observation group,and laparotomy was used in the control group.The operation time,collateral injury,intraoperative blood loss,postoperative anal exhaust time,postoperative hospitalization time,hospitalization expenses,postoperative liver function(albumin,TB),postoperative complications(bile leakage,incision infection)and stone residual rate were observed and compared between the two groups.Results In the observation group,28 patients underwent laparoscopic reoperation successfully,and 2 patients were transferred to laparotomy.In the observation group,after removing 2 patients transferred to laparotomy,there was no statistically significant difference in the operation time,intraoperative collateral injury,hospital expenses,postoperative incidence of biliary fistula,and stone residual rate between the two groups.Postoperative liver function,incision infection rate,intestinal function recovery and postoperative hospitalization time in the observation group were better than that in the laparotomy group(P<0.05).Conclusion It is safe and feasible to apply laparoscopy in the treatment of extrahepatic cholangiolithiasis with reasonable strategies and techniques of separation of adhesions under laparoscopy.Compared with traditional laparotomy,laparoscopy has a greater minimally invasive advantage in the treatment of extrahepatic cholangiolithiasis.Therefore,it should be the first choice for the reoperation of extrahepatic cholangiolithiasis,which is worthy of clinical promotion and application.
作者
蔡军
张彤
王翔
Cai Jun;Zhang Tong;Wang Xiang(Department of Hepatopancreatobiliary Surgery,Xinghua People's Hospital Affiliated to Yangzhou university,Xinghua,Jiangsu,225700,China)
出处
《当代医学》
2020年第31期57-60,共4页
Contemporary Medicine
基金
泰州市科技支撑社会发展计划项目(泰科技[2017]20号)。
关键词
腹腔镜
胆道再次手术
肝外胆管结石
Laparoscope
Biliary tract reoperation
Extrahepatic bile duct stones
