减少腹腔镜再次胆道手术并发症的策略(22例临床分析)  

Strategies to Reduce Complications of Laparoscopic Reoperation of the Biliary Tracts (22 Cases of Clinical Analysis)

作　　者：毛盛名[1] 何红苏 林建清 肖强[1] 刘岳[1] 陈文哲[1] 倪亚安 MAO Sheng-ming;HE Hong-su;LIN Jian-qing;XIAO Qiang;LIU Yue;CHEN Wen- zhe;NI Ya-an(Department of Hepatobiliary and Pancreatic Surgery,the Sixth Hospital Affiliated to Guang- zhou Medical University,Qiangyuan 511518,Guangdong,China)

机构地区：[1]广州医科大学附属第六医院肝胆胰腺外科,清远511518

出　　处：《中国现代手术学杂志》2018年第2期106-108,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨如何提高腹腔镜再次胆道手术的安全性、减少手术并发症的发生率。方法回顾性总结22例腹腔镜再次胆道手术的临床资料,分析总结如何提高手术安全性。结果 20例顺利完成腹腔镜再次胆道探查,2例中转开腹手术,中转率为9%。手术时间为(132±35)min,术中失血(93±32)ml,22例患者术中均未输血。所有患者均顺利出院,住院时间为(11.0±4.1)d。共发生并发症2例,并发症发生率为9%。其中胆漏1例,经持续引流后自愈。剑突下穿刺口感染1例,经加强换药后康复。术后随访无胆道狭窄及结石残留发生。结论腹腔镜再次胆道手术具有较高的安全性,较开放手术更有优越性。腹腔镜再次胆道手术应由具有丰富腹腔镜操作技术的高年资胆道外科医师进行。术前全面综合分析患者的病史及临床资料、周密的手术计划、耐心精细的手术操作、术中对胆道系统各种解剖标志及变异的准确辨认以及正确把握中转开腹的时机是保证手术安全的主要因素。Objective To explore the operative technique to improve the safety of laparoscopic reoperation of the biliary tracts and to reduce the incidence of surgical complications. Methods Laparoscopic reoperation of the biliary tracts was performed on 22 cases of choledocholithiasis. Clinical data of 22 cases of laparoscopic bile duct surgery were reviewed retrospectively. Results Twenty-two cases of laparoscopic cholangiotomy were performed successfully,and two cases converted to open surgery. The conversion rate was 9%. Operation time was（ 132 ± 35） min. Intraoperative blood loss was（ 93 ± 32） ml,and no blood transfusion was performed in 22 patients. All patients were discharged successfully,and the length of hospital stay was（ 11. 0± 4. 1） d. There were 2 cases（ 9%） suffered from complications,including one case of bile leakage,who was self-healing after 8 days of continuous drainage,and one case of the infection of the subxiphoid puncture. There were no biliary stricture and residual stones after the operation. Conclusions Laparoscopic reoperation of the biliary tracts is safe and effective. The operation should be performed by a high-year biliary surgeon with superior laparoscopic skills. Comprehensive analysis of the history and clinical data of patients with a detailed operation plan,careful operation,intraoperative various anatomical marks of biliary system and accurate recognition and correct grasp of the timing of the conversion of open surgery are the main factors to ensure the safety of the operation.

关 键 词：腹腔镜手术 再次胆道手术 胆石症 手术并发症 手术技巧 

分 类 号：R657.4[医药卫生—外科学]