肝圆韧带入路在腹腔镜再次胆道取石术中的应用价值  

Application value of ligamentum teres hepatis approach in laparoscopic biliary reoperation

作　　者：孙科[1] 肖宏[1] 陈安平[1] 尹思能[1] Sun Ke;Xiao Hong;Chert Anping;Yin Sineng(Department of Hepatic-biliary-pancreatic Surgery,Chengdu Second People's Hospital,Chengdu 610017,China)

机构地区：[1]成都市第二人民医院肝胆胰外科,成都610017

出　　处：《中华消化外科杂志》2019年第2期160-164,共5页Chinese Journal of Digestive Surgery

基　　金：四川省卫生局基金资助项目(17PJ113).

摘　　要：目的探讨肝圆韧带入路在腹腔镜再次胆道取石术中的应用价值。方法采用回顾性队列研究方法。收集2014年1月至2018年1月成都市第二人民医院收治的58例行腹腔镜再次胆道取石术的肝胆管结石病复发患者的临床资料;男33例,女25例;平均年龄54岁,年龄范围为31~85岁。58例患者中,31例行腹腔镜再次胆道取石术,术中采用肝圆韧带入路进行解剖和定位,设为肝圆韧带组;27例行腹腔镜再次胆道取石术,术中采用常规方法进行解剖和定位,设为常规手术组。观察指标:(1)术中情况。(2)术后恢复情况。(3)随访情况。采用电话及门诊方式进行随访,术后3、6、12个月行胆道彩色多普勒超声检查,以后每12个月复查1次胆道彩色多普勒超声,了解患者胆道结石复发情况。随访时间截至2018年8月。正态分布的计量资料以Mean±SD表示,组间比较采用t检验,偏态分布的计量资料以M(范围)表示,组间比较采用秩和检验。计数资料以绝对数表示,组间比较采用四格表χ2检验或Fisher确切概率法。结果(1)术中情况:两组患者均顺利完成腹腔镜再次胆道取石术,无中转开腹和围术期死亡。31例肝圆韧带组患者术中探查发现腹壁网膜粘连7例、肝门部网膜粘连8例、肝门部肠粘连16例。27例常规手术组患者术中探查发现腹壁网膜粘连5例、肝门部网膜粘连8例、肝门部肠粘连14例。肝圆韧带组患者手术时间、术中出血量分别为(125±24)min、40mL(15~100mL),常规手术组上述指标分别为(150±36)min、55mL(20~350mL),两组比较,差异均有统计学意义(t=-3.162,Z=-2.768,P<0.05);肝圆韧带组患者的胆管处理方式为胆总管一期缝合10例、T管引流21例,术中结石取尽26例;常规手术组上述指标分别为9、18例,23例,两组比较,差异均无统计学意义(χ^2=0.008,0.019,P>0.05)。术后胆道残留结石患者均携带T管8周后于门诊经T管窦道采用胆道镜取尽结石。(2)术ObjectiveTo investigate the application value of ligamentum teres hepatis approach in laparoscopic biliary reoperation.MethodsThe retrospective cohort study was conducted. The clinical data of 58 patients with recurrent hepatolithiasis who underwent laparoscopic biliary reoperation in the Chengdu Second People′s Hospital were collected. There were 33 males and 25 females, aged from 31 to 85 years, with an average age of 54 years. Thirty-one of 58 patients who underwent laparoscopic biliary reoperation using ligamentum teres hepatis approach were divided into the ligamentum teres hepatis group, and 27 patients who underwent laparoscopic biliary reoperation using regular anatomy and positioning were divided into the regular operation group. Observation indicators: (1) intraoperative situations;(2) postoperative recovery;(3) follow-up. Follow-up using telephone interview and outpatient examination was performed to detect the recurrence of bile duct stone up to August 2018. Doppler ultrasonography of biliary tract was performed once at 3, 6 and 12 months postoperatively and once at every 12 months after 1 year. Measurement data with normal distribution were represented as Mean±SD and comparison between groups was analyzed by the t test.Measurement data with skewed distribution were described as M (range) and comparison between groups was analyzed by rank sum test. Count data were analyzed using the four-grid table chi-square test or Fisher exact probability.Results(1) Intraoperative situations: all patients underwent successful laparoscopic biliary reoperation, without conversion to open surgery and perioperative death. During the intraoperative exploration, 7, 8, 16 patients in the ligamentum teres hepatis group and 5, 8, 14 patients in the regular operation group were respectively found peritoneal omental adhesions, hilar omental adhesions and hilar intestinal adhesions. The operation time and volume of intraoperative blood loss were (125±24)minutes, 40 mL(range, 15-100 mL) in the ligamentum teres hepatis group

关 键 词：肝胆管结石病 肝圆韧带人路 外科手术 再次胆道手术 腹腔镜检查 

分 类 号：R657.4[医药卫生—外科学]