临床肝胆病杂志
臨床肝膽病雜誌
림상간담병잡지
CHINESE JOURNAL OF CLINICAL HEPATOLOGY
2014年
8期
768-771
,共4页
梅永%彭慈军%朱洪江%舒德军%李伟男%李雄雄
梅永%彭慈軍%硃洪江%舒德軍%李偉男%李雄雄
매영%팽자군%주홍강%서덕군%리위남%리웅웅
外科手术,微创性%剖腹术%腹腔镜胆总管探查术%难点%对策
外科手術,微創性%剖腹術%腹腔鏡膽總管探查術%難點%對策
외과수술,미창성%부복술%복강경담총관탐사술%난점%대책
surgical procedures,minimally invasive%laparotomy%laparoscopic common bile duct exploration%difficulty%countermeasure
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。
目的:探討上腹部術後腹腔鏡膽總管探查術(LCBDE)的難點與對策。方法迴顧性分析遵義醫學院附屬醫院2008年1月-2013年10月期間72例上腹部手術後行LCBDE的臨床病例資料。對術中的睏難情況及處理進行總結分析。數據分析採用SPSS19.0統計軟件,計量資料組間比較採用成組t檢驗。結果術中齣現相對睏難情況共16例。其中9例嚴重腹腔及術區粘連,4例膽總管確認睏難,3例取石睏難。總體手術時間為(164.36±19.06)min,術中睏難組為(179.31±13.25)min,非術中睏難組為(160.09±18.37)min。術中睏難組手術時間明顯長于非術中睏難組和總體手術時間,差異有統計學意義(t=-3.898,P=0.000;t=-2.976,P=0.004)。非術中睏難組與總體手術時間比較,差異無統計學意義(t=-1.278,P=0.204)。結論上腹部術後LCBDE是一項高難度、高風險、高技術含量的手術。術中睏難情況會導緻手術時間延長,鬚根據術中具體情況,採用相應的箇體化對策,以確保手術成功。
목적:탐토상복부술후복강경담총관탐사술(LCBDE)적난점여대책。방법회고성분석준의의학원부속의원2008년1월-2013년10월기간72례상복부수술후행LCBDE적림상병례자료。대술중적곤난정황급처리진행총결분석。수거분석채용SPSS19.0통계연건,계량자료조간비교채용성조t검험。결과술중출현상대곤난정황공16례。기중9례엄중복강급술구점련,4례담총관학인곤난,3례취석곤난。총체수술시간위(164.36±19.06)min,술중곤난조위(179.31±13.25)min,비술중곤난조위(160.09±18.37)min。술중곤난조수술시간명현장우비술중곤난조화총체수술시간,차이유통계학의의(t=-3.898,P=0.000;t=-2.976,P=0.004)。비술중곤난조여총체수술시간비교,차이무통계학의의(t=-1.278,P=0.204)。결론상복부술후LCBDE시일항고난도、고풍험、고기술함량적수술。술중곤난정황회도치수술시간연장,수근거술중구체정황,채용상응적개체화대책,이학보수술성공。
Objective To investigate the technical difficulties of laparoscopic common bile duct exploration (LCBDE)and their counter-measures 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 intraopera-tive 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 encoun-tering intraoperative difficulties,and 160.09 ±18.37 min for those not encountering intraoperative difficulties;the operative time was signifi-cantly 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 sur-gery,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.