开腹胆道手术后腹腔镜胆道再手术29例分析  

Laparoscopic reoperation on biliary tract in 29 cases with previous open surgery

作　　者：胡三元[1] 陈波[1] 王可新[1] 张光永[1] 张海峰[1] 刘崇忠[1] 

机构地区：[1]山东大学齐鲁医院普外科,济南250012

出　　处：《中华普通外科杂志》2007年第1期46-48,共3页Chinese Journal of General Surgery

摘　　要：目的 探讨开腹胆道手术后腹腔镜胆道再手术的可行性和安全性.方法 1992年4月至2005年12月共完成腹腔镜胆道手术3485例,29例有开腹胆道手术史.分析29例腹腔镜胆道再手术的临床资料,其中8例合并有肝内胆管结石（结石限于Ⅰ～Ⅱ级胆管）;14例胆总管结石数＞3个;21例胆总管结石最大直径＞1.0 cm;3例曾首先行内镜括约肌切开术（endoscopic sphincterotomy,EST）未成功.28例行胆总管切开取石及T管引流术（LCTD）者胆总管直径均＞1.0 cm.结果 本组手术时间为75～190 min,平均125min,除1例在原切口部位做小切口用直角钳将结石夹碎取出外,其余手术均顺利完成,无1例发生胆漏、胆管损伤等严重并发症,平均住院5.5 d（2～14 d）.术后残余结石3例,经T管窦道取出.结论 开腹胆道手术后腹腔镜胆道再手术的创伤小、术后恢复快,由操作熟练的腹腔镜医师执行手术是安全的.Objective To explore the feasibility and safety of laparoscopic reoperation on 29 cases with previous open surgery on biliary tract. Methods Laparoscopic operation on biliary tract was performed on 3485 patients from April 1992 to December 2005. Of these patients, 29 had a previous open operation on biliaty tract. Among which 8 cases had intrahepatic duct calculus（ localized in the 2nd and the 3rd order of hepatic duct）, 14 cases had 3 or more common duct stones, 21 cases had at least one common duct stone larger than 1 cm, 3 cases had had failed attempt of EST and diameter of common bile duct in 28 cases was larger than 1 cm. Results Procedure was successful in 28 patients. One patient was converted to open operation. There was no severe complication and the average hospitalization was 5. 5 d （2 - 14 d）. Retained calculus existed in 3 cases and were taken out through sinus tract of T tube. Conclusions Laparoscopic reoperation is minimally invasive, safe and feasible for patients with a history of previous open biliary surgery.

关 键 词：胆道外科手术 腹腔镜 再手术 胆管损伤 

分 类 号：R686[医药卫生—骨科学]