上腹部术后行腹腔镜胆总管探查术的难点与对策

梅永; 彭慈军; 朱洪江; 舒德军; 李伟男; 李雄雄

doi:10.3969/j.issn.1001-5256.2014.08.017

上腹部术后行腹腔镜胆总管探查术的难点与对策

DOI: 10.3969/j.issn.1001-5256.2014.08.017

遵义医学院附属医院肝胆外科

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中图分类号: R657.42
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出版历程
- 收稿日期: 2014-06-12
- 出版日期: 2014-08-20

Technical difficulties of laparoscopic common bile duct exploration and their countermeasures for patients with history of upper abdominal surgery

Department of Hepatobiliary Surgery, The Affiliated Hospital of Zunyi Medical College

摘要

摘要: 目的探讨上腹部术后腹腔镜胆总管探查术（LCBDE）的难点与对策。方法回顾性分析遵义医学院附属医院2008年1月-2013年10月期间72例上腹部手术后行LCBDE的临床病例资料。对术中的困难情况及处理进行总结分析。数据分析采用SPSS19.0统计软件,计量资料组间比较采用成组t检验。结果术中出现相对困难情况共16例。其中9例严重腹腔及术区粘连,4例胆总管确认困难,3例取石困难。总体手术时间为（164.36±19.06）min,术中困难组为（179.31±13.25）min,非术中困难组为（160.09±18.37）min。术中困难组手术时间明显长于非术中困难组和总体手术时间,差异有统计学意义（t=-3.898,P=0.000;t=-2.976,P=0.004）。非术中困难组与总体手术时间比较,差异无统计学意义（t=-1.278,P=0.204）。结论上腹部术后LCBDE是一项高难度、高风险、高技术含量的手术。术中困难情况会导致手术时间延长,须根据术中具体情况,采用相应的个体化对策,以确保手术成功。
- 外科手术,微创性 /
- 剖腹术 /
- 腹腔镜胆总管探查术 /
- 难点 /
- 对策
Abstract: Objective To investigate the technical difficulties of laparoscopic common bile duct exploration (LCBDE) and their countermeasures for patients with a history of upper abdominal surgery.Methods A retrospective analysis was performed on the clinical data of 72 patients with a history of upper abdominal surgery who underwent LCBDE at our hospital from January 2008 to October 2013.The intraoperative difficulties and their countermeasures were summarized and analyzed.Results Intraoperative difficulties occurred in 16 patients;severe adhesions in the abdominal cavity and operation region were found in 9 cases, difficult identification of the common bile duct in 4 cases, and difficult removal of stones in 3 cases.The operative time was 164.36 ± 19.06 min for all patients, 179.31 ± 13.25 min for patients encountering intraoperative difficulties, and 160.09 ± 18.37 min for those not encountering intraoperative difficulties;the operative time was significantly longer in patients encountering intraoperative difficulties than in those not encountering intraoperative difficulties and in all patients (t =-3.898, P =0.000;t =-2.976, P = 0.004) , but the operative time of patients not encountering intraoperative difficulties was not significantly different from that of all patients (t =- 1.278, P = 0.204) .Conclusion For patients with a history of upper abdominal surgery, LCBDE is an operation with high difficulty, high risk, and high technical requirement.In case of intraoperative difficulties, which would prolong the operative time, individualized countermeasures should be taken to ensure successful surgery.
- surgical procedures, minimally invasive /
- laparotomy /
- laparoscopic common bile duct exploration /
- difficulty /
- countermeasure

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参考文献(14)

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