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Clinical observations of the effects of laparoscopic choledochoduodenostomies in 84 cases
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摘要:
目的评估腹腔镜胆总管十二指肠吻合术(LCD)在治疗晚期恶性梗阻性黄疸中的临床疗效,总结手术技术经验。方法回顾分析自2011年1月至2012年10月完成LCD的84例患者,总结围手术期临床资料,观察指标包括手术时间、术中出血量、术后住院时间、术后排气时间、术后肝功能恢复情况、术后生存期、住院费用、术后并发症。结果成功实施LCD 83例,中转1例,二次手术8例,平均手术时间(103±43)min,术中平均失血量(20±17)ml,术后平均住院时间(9.0±2.1)d,术后肝功能自(3.4±1.6)d开始明显恢复。术后平均排气时间(2.5±1.2)d,住院平均费用为(28359±4523)元。术后随访2～22个月,术后并发症少。结论 LCD具有明显的快速降黄的临床效果,且与传统的胰腺十二指肠切除术相比,患者住院费用明显降低,手术风险小,保证患者快速康复,随访临床效果良好。
Abstract:Objective To summarize the surgery-related factors and patient outcomes of laparoscopic choledochoduodenostomy (LCD) used in our hospital for treatment of advanced malignant obstructive jaundice.Methods Eight-four patients who underwent LCD between January 2011 and October 2012 in the First Hospital of Jilin University were retrospectively enrolled in the study.The perioperative, postoperative and follow-up (range: 2-22 months) clinical data were analyzed for each patient.Results The LCD procedure was completed successfully in 83 cases, with only one case requiring conversion to open cholecystectomy.Eight cases developed complications that required a second operation (jaundice, n=3;postoperative bleeding, n=2;gastrointestinal obstruction, n=3) .The average operation time was (103±43) min.The average postoperative hospital stay was (9.0±2.1) days.The average intraoperative blood loss was (20±17) ml.The average length of time from the surgery to restoration of liver function was (3.4±1.6) days.The postoperative average time to first flatus was (2.5±1.2) days.The average hospitalization cost was (28359±4523) yuan.Conclusion LCD treatment of advanced malignant obstructive jaundice can quickly reduce the level of bilirubin with relatively low-risk of complications.The shorter durations of hospitalization and rehabilitation associated with this procedure make LCD a low-cost, as well as effective, clinical treatment.
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Key words:
- jaundice /
- obstructive /
- choledochostomy /
- laparoscopy
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