有上腹部手术史的胆总管结石患者的腹腔镜治疗  

Laparoscopic common bile duct stone extraction in patients with a history of previous upper abdominal surgery

作　　者：李欣[1] 侯纯升[1] 徐智[1] 王立新[1] 凌晓峰[1] 王港[1] 崔龙[1] 修典荣[1] 

机构地区：[1]北京大学第三医院普通外科,100191

出　　处：《中华普通外科杂志》2016年第3期215-217,共3页Chinese Journal of General Surgery

摘　　要：目的 探讨既往有上腹部手术史的患者行腹腔镜胆总管探查取石术的可行性及安全性.方法 回顾性分析2013年10月至2015年9月54例既往有上腹部手术史,此次行腹腔镜胆总管探查取石术患者的临床资料.总结手术时间,出血量,术后住院时间以及术后并发症等资料.结果 既往手术包括胃切除术后16例,胆囊切除或保胆取石术后19例,胆管切开取石术后19例.与既往手术间隔时间为3d至37年,中位时间为9年.腹腔镜胆总管切开取石术30例,腹腔镜经胆囊管取石24例,胆总管结石直径为（10±8）mm.手术时间（154±41）min,出血量（37±29） ml,术后住院时间（6±2）d.术后胆漏2例,均经保守治疗后痊愈.中转开腹l例.因结石嵌顿于Odii括约肌结石残留1例.结论 有上腹部手术史的腹腔镜胆总管取石术创伤小、恢复快,对于资深的腹腔镜胆道专业医师安全可行.Objective To study the feasibility and safety of laparoscopic common bile duct explorations with previous upper abdominal surgery.Methods Clinical data of 54 cases undergoing laparoscopic common bile duct explorations from October 2013 to September 2015 were analyzed.Operation time,blood loss,post-operative hospital stay and complications were summarized and analyzed.Results Previous operation included gastrectomy in 16 cases,cholecystectomy in 19 cases,common bile duct exploration in 19 cases.This time 30 patients underwent laparoscopic choledocholithotomies and 24 did laparoscopic transcystic common bile duct stone extraction.The size of common bile duct stones was （10 ±8）mm,operation time was （154 ± 41）min,blood loss was （37 ± 29）ml,the post-operative hospital stay was （6 ± 2） d.Bile leakage in 2 cases was cured by conservative treatments.There was one conversion to open surgery.Residual stones were found in one case incarcerated in the Odii＆#39; s sphincter.Conclusions Laparoscopic common bile duct exploration and stone extraction in patients with a history of previous upper abdominal operations can be a microinvasive and safe procedure in hands of experienced surgeons.

关 键 词：胆总管结石 腹腔镜 

分 类 号：R657.4[医药卫生—外科学]