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腹腔镜联合胆道镜再手术治疗肝内外胆管结石35例分析
Clinical effect of laparoscopic reoperation combined with choledochoscope in treatment of intra- and extrahepatic bile duct stones: analysis of 35 cases
文章发布日期:2013年06月07日  来源:  作者:吴黎明,程彩涛,王江华,等  点击次数:1698次  下载次数:450次

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【摘要】:目的探讨腹腔镜联合胆道镜再次手术治疗肝内外胆管结石的可行性以及安全性。方法以2008年1月至2012年5月35例接受腹腔镜胆道再次手术的肝内外胆管结石患者作为腹腔镜组,同期50例接受开腹手术的复发性肝内外胆管结石患者作为开腹手术组,采用t检验比较两组患者在术后早期下床活动、肠功能恢复以及住院时间等方面的差异,两组间切口感染率的比较采用χ2检验。结果35例腹腔镜组病例中32例顺利完成腹腔镜手术,2例因黏连严重中转开腹手术,1例因出现皮下气肿中转开腹。腹腔镜组再次胆道手术平均手术时间148(105~200)min;围手术期均无出血、胆漏并发症。所有病例均行T管引流。术后腹腔引流管置管时间2~5 d,术后住院时间5~8 d。腹腔镜组均无切口感染发生。经统计学分析,在术后早期下床活动时间、肠功能恢复时间、术后住院时间以及切口感染率方面,腹腔镜组明显优于开腹手术组,差异有统计学意义(P<0.05)。腹腔镜组3例术后2个月因残留结石行纤维胆道镜经窦道取石术。术后随访6~24个月腹腔镜组所有病例未发现结石复发。结论腹腔镜胆道再次手术的创伤小、并发症少、术后恢复快,在掌握适应症的情况下选择适当病例用于治疗肝内外胆管结石是安全有效的。
【Abstract】:ObjectiveTo investigate the feasibility and safety of laparoscopic reoperation combined with choledochoscope in the treatment of intra- and extrahepatic bile duct stones. MethodsThe 35 patients with intra- and extrahepatic bile duct stones who underwent laparoscopic bile duct reoperation from January 2008 to May 2012 were selected as a laparoscopic treatment group; 50 patients with recurrent intra- and extrahepatic bile duct stones who underwent open surgery in the same period were selected as an open surgery group. The t-test was used to compare the two groups in terms of off-bed activity early after operation, recovery of intestinal function, and length of hospital stay; the chi-square test was used to compare the incision infection rate between the two groups. ResultsAmong the 35 cases of intra- and extrahepatic bile duct stones, 32 completed laparoscopic surgery, 2 had the procedure converted to open surgery due to severe adhesion, and 1 had the procedure converted to open surgery due to subcutaneous emphysema. In the laparoscopic treatment group, the mean operative time of laparoscopic bile duct reoperation was 148 min (range, 105-200 min); there were no bleeding and bile leak in the perioperative period. All patients underwent T-tube drainage; postoperative peritoneal drainage was performed for 2-5 d; the mean length of hospital stay after operation was 5-8 d. No case of incision infection occurred in the laparoscopic treatment group. The laparoscopic treatment group had a significantly better outcome than the open surgery group in terms of time to off-bed activity early after operation, time to recovery of intestinal function, length of hospital stay after operation, and incision infection rate (P<0.05). In the laparoscopic treatment group, 3 cases had retained bile duct stones, and the stones were taken out through the sinus tract using a fiber choledochoscope at 2 months after operation. All cases were followed up for 6-24 months after operation, and no recurrence was found in the laparoscopic treatment group. ConclusionLaparoscopic bile duct reoperation is minimally invasive and causes few complications, and the patients have rapid recovery after this procedure. Laparoscopic bile duct reoperation is safe and effective in the patients with intra- and extrahepatic bile duct stones who have the indications for this procedure.
【关键字】:胆结石;腹腔镜;内窥镜检查,胆道系统;再手术
【Key words】:cholelithiasis; laparoscope; endoscopy, digestive system; reoperation
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