腹腔镜下胆管空肠袢式吻合术在良性胆道疾病中的应用  

Laparoscopic Loop Cholangiojejunostomy for Benign Biliary Tract Diseases

作　　者：王文儿[1,2] 周旅[1,2] 宋新[1,2] 

机构地区：[1]湖南省湘西自治州人民医院 [2]吉首大学第一附属医院肝胆外科,吉首416000

出　　处：《中国现代手术学杂志》2015年第2期107-111,共5页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨全腹腔镜下胆管空肠袢式吻合术在良性胆道疾病手术中的安全性、可行性和手术技巧。方法回顾性分析我科2012年3月～2014年12月行全腹腔镜下胆管空肠袢式吻合术的17例良性胆道疾病患者（全腹腔镜组）的临床资料,并以同期行开腹手术的39例（开腹组）作为对照。记录并比较两组患者手术时间、术中失血量、术后离床活动时间、胃肠道恢复时间、术后止痛剂使用频次及术后住院时间,观察并比较两组患者术后并发症情况。结果两组均顺利手完成手术,腹腔镜组无中转开腹病例。与开腹组比较,全腹腔镜组手术时间长,术后第一次离床活动时间和术后肛门恢复排气时间早,术后止痛剂的使用少,术后住院时间短,差异均具有统计学意义（P〈0.05）。全腹腔镜组术后发生胆漏2例,胰漏1例,发热（〉38.5℃）3例,切口感染1例及肺部感染2例;开腹组术后发生胆漏2例,腹腔内出血1例,发热5例,切口感染5例及肺部感染4例。两组术后并发症比较,差异均无统计学意义（P〉0.05）。两组患者均获随访,随访时间1.5～34个月。两组患者术前症状均改善,无粘连性肠梗阻、吻合口狭窄、严重反流性胆管炎发生,胆总管结石患者随访期间未见结石复发。结论在严格掌握手术适应证和技术成熟的前提下,全腹腔镜下胆管空肠袢式吻合术是安全、有效、可行的。Objective To discuss the safety,feasibility and surgical skills of laparoscopic loop cholangiojejunostomy in the treatment of benign biliary tract diseases. Methods The clinical data of 17 cases with benign biliary tract diseases（ as total laparoscopic group） performed total laparoscopic loop cholangiojejunostomy from were March 2012 to December 2014 was analyzed retrospectively. The homeochronous 39 cases with benign biliary tract diseases received laparotomy were regard as the control group. The operative duration,intra-operative blood loss,post-operative off-bed time,gastrointestinal restoration time,frequency of anodyne usage,post-operative hospital stays and post-operative complications were compared between two groups. Results All operations were accomplished successfully. No one case conversed to laparotomy in the total laparoscopic group. Compare to the control group,the operative duration was longer,the first postoperative off-bed time and the gastrointestinal restoration time was earlier,the frequency of anodyne usage was less,post-operative hospital stays was short in the total laparoscopic group,and there was statistical difference between two groups（ P 〈0. 05）. The post-operative complications such as bile leakage in 2 cases,pancreatic leakage in 1 case,fever in 3 cases,wound infection in 1 case and pulmonary infection in 2 cases in laparoscopic group,and bile leakage in 2 cases,intra-abdominal hemorrhage in 1 case,fever in 5 cases,wound infection in 5 cases and pulmonary in 4 cases. No statistical difference in post-operative complication rate between two groups（ P 〉0. 05）. All cases were followed up for 1. 5 to 34 months. All cases improved without adhesive ileus,stenostomia,serious reflux cholangitis and choledocholith recurrence. Conclusion The total laparoscopic loop cholangiojejunostomy is safety,effective and feasible for benign bile tract diseases based on serious selection of indication and skilled grasp of procedure.

关 键 词：腹腔镜检查 吻合术 外科 胆总管结石 胆管狭窄 胆总管囊肿 

分 类 号：R657.4[医药卫生—外科学]