CAJ | 학술논문

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。
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.