中国微创外科杂志
中國微創外科雜誌
중국미창외과잡지
Chinese Journal of Minimally Invasive Surgery
2015年
11期
1004-1006
,共3页
腹腔镜%二次胆道手术%胆总管结石
腹腔鏡%二次膽道手術%膽總管結石
복강경%이차담도수술%담총관결석
Laparoscopy%Reoperation of bile duct%Choledocholithiasis
目的：探讨既往有胆道手术史患者胆总管结石再次行腹腔镜胆总管探查术的可行性和安全性。方法对我院2012年1月～2014年1月31例既往有胆道手术史的胆总管结石行腹腔镜下胆总管切开取石手术。腹腔镜下分离粘连，切开胆总管，置入胆道镜取出结石，置入T管行胆道引流。结果31例腹腔镜下胆总管切开取石手术均顺利完成，无中转开腹。术中生命体征平稳，手术时间65～125 min，（118±21）min，术中出血量10～75 ml，（39±19）ml。术中胃损伤2例，腹腔镜下缝合修补，恢复良好。术后胃肠功能恢复时间24～48 h，（27±13）h。术后48～72 h拔出腹腔引流管。术后发生胆漏1例，切口感染1例，无出血、胃肠漏、胰腺炎等并发症。术后住院时间6～9 d，（7．0±1．5）d。31例随访3～24个月，平均15．6月，均恢复良好，无胆道狭窄、结石复发。结论腹腔镜在二次胆道手术治疗胆总管结石是可行、安全的。
目的：探討既往有膽道手術史患者膽總管結石再次行腹腔鏡膽總管探查術的可行性和安全性。方法對我院2012年1月～2014年1月31例既往有膽道手術史的膽總管結石行腹腔鏡下膽總管切開取石手術。腹腔鏡下分離粘連，切開膽總管，置入膽道鏡取齣結石，置入T管行膽道引流。結果31例腹腔鏡下膽總管切開取石手術均順利完成，無中轉開腹。術中生命體徵平穩，手術時間65～125 min，（118±21）min，術中齣血量10～75 ml，（39±19）ml。術中胃損傷2例，腹腔鏡下縫閤脩補，恢複良好。術後胃腸功能恢複時間24～48 h，（27±13）h。術後48～72 h拔齣腹腔引流管。術後髮生膽漏1例，切口感染1例，無齣血、胃腸漏、胰腺炎等併髮癥。術後住院時間6～9 d，（7．0±1．5）d。31例隨訪3～24箇月，平均15．6月，均恢複良好，無膽道狹窄、結石複髮。結論腹腔鏡在二次膽道手術治療膽總管結石是可行、安全的。
목적：탐토기왕유담도수술사환자담총관결석재차행복강경담총관탐사술적가행성화안전성。방법대아원2012년1월～2014년1월31례기왕유담도수술사적담총관결석행복강경하담총관절개취석수술。복강경하분리점련，절개담총관，치입담도경취출결석，치입T관행담도인류。결과31례복강경하담총관절개취석수술균순리완성，무중전개복。술중생명체정평은，수술시간65～125 min，（118±21）min，술중출혈량10～75 ml，（39±19）ml。술중위손상2례，복강경하봉합수보，회복량호。술후위장공능회복시간24～48 h，（27±13）h。술후48～72 h발출복강인류관。술후발생담루1례，절구감염1례，무출혈、위장루、이선염등병발증。술후주원시간6～9 d，（7．0±1．5）d。31례수방3～24개월，평균15．6월，균회복량호，무담도협착、결석복발。결론복강경재이차담도수술치료담총관결석시가행、안전적。
Objective To investigate the feasibility and safety of reoperation of laparoscopic common bile duct exploration in the management of choledocholithiasis in patients with biliary surgical history. Methods Thirty-one patients with choledocholithiasis and biliary surgical history were performed by reoperation of laparoscopic common bile duct exploration between January 2012 and January 2014 in our hospital.The adhesion was disconnected under the laparoscopy, and then the common bile duct was opened to introduce an endoscope for stone removal.A T-tube was placed for drainage. Results The operations were successfully completed in all the 31 cases, without conversion to open surgery.The vital signs of those patients were smooth during the operation.The operation time was 65-125 min, with a mean of (118 ±21) min.The volume of blood loss was 10-75 ml during operations, with a mean of (39 ±19) ml.The patients could take food normally 24-48 h after operation, with a mean of (27 ±13) h.The drainage tubes were pulled out 48 -72 hours after operation.No severe complications, such as residual stones, bleeding, gastrointestinal leakage, or pancreatitis happened during hospitalization, except for 1 case of biliary leakage and 1 case of incision infection.The patients stayed in hospital for 6-9 days after operation, with a mean of (7.0 ±1.5) days.No biliary stricture or recurrence was found during a 3-24 months of follow-up (mean, 15.6 months) in 31 cases. Conclusion Reoperation of laparoscopic common bile duct exploration by experienced laparoscopic specialists for choledocholithiasis in patients with biliary surgical history is relatively safe and effective.
