中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
14期
6405-6409
,共5页
李欢送%姜新春%齐敦峰%张昕辉%孟凡军
李歡送%薑新春%齊敦峰%張昕輝%孟凡軍
리환송%강신춘%제돈봉%장흔휘%맹범군
胆总管探查术%胆道损伤%外科手术%手术技术
膽總管探查術%膽道損傷%外科手術%手術技術
담총관탐사술%담도손상%외과수술%수술기술
Choledochotomy%Biliary tract injuries%Surgical procedures,operative%Operative technique
目的：评价选择性左手控制技术在胆总管探查术中降低医源性胆管损伤的临床应用价值。方法回顾性分析我院2006年6月至2012年3月77例选择采用左手控制技术施行胆总管探查术病例临床资料，统计其手术方式、及术中术后相关并发症，与同期77例非左手控制组胆总管探查术病例资料对比。结果左手控制组较对照组在手术时间[（96.376±24.099）min vs.（96.883±20.809）min）]及术后住院时间[（13.909±10.236）d vs.（13.181±8.465）d）]比较无统计学差异（P＞0.05），术后并发症发生率（16.883%vs.38.961%）有明显统计学差异（P＜0.05）。左手控制组术中出血量稍多；对照组术中胆道出血5例、胆管下段管壁挫伤6例，左手控制组各为2例；对照组胆管下端后壁穿孔1例及十二指肠侧壁穿孔2例，左手控制组无胆管或十二指肠穿孔病例；左手控制组术中发现十二指肠乳头肿瘤及炎性结节各1例，对照组未发现异常病变。结论选择性采用左手控制技术应用于胆总管探查术，增加了手术安全性，减少了医源性胆总管下端及壶腹部周围组织损伤的概率，有助于胆总管下端隐匿性病变的早期发现。
目的：評價選擇性左手控製技術在膽總管探查術中降低醫源性膽管損傷的臨床應用價值。方法迴顧性分析我院2006年6月至2012年3月77例選擇採用左手控製技術施行膽總管探查術病例臨床資料，統計其手術方式、及術中術後相關併髮癥，與同期77例非左手控製組膽總管探查術病例資料對比。結果左手控製組較對照組在手術時間[（96.376±24.099）min vs.（96.883±20.809）min）]及術後住院時間[（13.909±10.236）d vs.（13.181±8.465）d）]比較無統計學差異（P＞0.05），術後併髮癥髮生率（16.883%vs.38.961%）有明顯統計學差異（P＜0.05）。左手控製組術中齣血量稍多；對照組術中膽道齣血5例、膽管下段管壁挫傷6例，左手控製組各為2例；對照組膽管下耑後壁穿孔1例及十二指腸側壁穿孔2例，左手控製組無膽管或十二指腸穿孔病例；左手控製組術中髮現十二指腸乳頭腫瘤及炎性結節各1例，對照組未髮現異常病變。結論選擇性採用左手控製技術應用于膽總管探查術，增加瞭手術安全性，減少瞭醫源性膽總管下耑及壺腹部週圍組織損傷的概率，有助于膽總管下耑隱匿性病變的早期髮現。
목적：평개선택성좌수공제기술재담총관탐사술중강저의원성담관손상적림상응용개치。방법회고성분석아원2006년6월지2012년3월77례선택채용좌수공제기술시행담총관탐사술병례림상자료，통계기수술방식、급술중술후상관병발증，여동기77례비좌수공제조담총관탐사술병례자료대비。결과좌수공제조교대조조재수술시간[（96.376±24.099）min vs.（96.883±20.809）min）]급술후주원시간[（13.909±10.236）d vs.（13.181±8.465）d）]비교무통계학차이（P＞0.05），술후병발증발생솔（16.883%vs.38.961%）유명현통계학차이（P＜0.05）。좌수공제조술중출혈량초다；대조조술중담도출혈5례、담관하단관벽좌상6례，좌수공제조각위2례；대조조담관하단후벽천공1례급십이지장측벽천공2례，좌수공제조무담관혹십이지장천공병례；좌수공제조술중발현십이지장유두종류급염성결절각1례，대조조미발현이상병변。결론선택성채용좌수공제기술응용우담총관탐사술，증가료수술안전성，감소료의원성담총관하단급호복부주위조직손상적개솔，유조우담총관하단은닉성병변적조기발현。
Objective To evaluate the clinical value of the left hand control technique applied to the choledochotomy to reduce the probability of iatrogenic biliary tract injury. Methods Between June 2006 and Mar 2012, 77 patients underwent open exploratory choledochotomy using left hand control technique, and another 77 corresponding period patients underwent the same operations without using this technique were randomized selected as the control group, the clinical records of the two groups were retrospectively compared and analyzed statistically. Results Comparisons of operation time[(96.376±24.099) min vs. (96.883±20.809)min] and postoperative hospital stay[(13.909±10.236)d vs. (13.181±8.465)d] between left hand control group and control group showed no significant difference(P>0.05), while postoperative complications comparison(16.883% vs. 38.961%)showed statistic difference(P<0.05). Five patients got intraoperative biliary tract hemorrhage,and six cases got lower segment wall contusion of common bile duct in the control group, while only two cases occurred respectively in the left hand control group. No cases complicated with perforation of the common bile duct back wall and duodenal perforation introoperatively in the left hand control group,while three patients in the control group. One duodenal papillary tumor and one inflammatory nodules were detected respectively in the left hand control group. Conclusion The left hand control technique being selectively applied to the exploratory choledochotomy can increase the operation security, reduce iatrogenic damage of the bile duct and peripheral ampullar region tissue,and contribute to the early detection of occult lesions of the distal common bile duct.
