腹腔镜在再次胆道手术联合肝切除术中的临床研究  

Clinical research of laparoscopy in biliary reoperation combined with hepatectomy

作　　者：彭永海[1] 杨倩[2] 陈熙[1] 胡朝辉[1] 罗华[1] 吕汝琦[3] PENG Yonghai;YANG Qian;CHEN Xi;HU Zhaohui;LUO Hua;LV Ruqi(Department of Hepatobiliary Surgery,Mianyang Municipal Central Hospital, Mianyang,Sichuan 621000,China;;Department of Orthopedics,Mianyang Municipal Hospital of Traditional Chinese Medicine,Mianyang,Sichuan 621000,China;Department of Emergency,Mianyang Municipal Central Hospital,Mianyang,Sichuan 621000,China)

机构地区：[1]四川省绵阳市中心医院肝胆外科,621000 [2]四川省绵阳市中医医院骨科,621000 [3]四川省绵阳市中心医院急诊科,621000

出　　处：《重庆医学》2018年第21期2807-2811,共5页Chongqing medicine

摘　　要：目的探讨腹腔镜在再次胆道手术联合肝切除术中的临床疗效及安全性。方法以2012年1月至2017年6月绵阳市中心医院因胆道术后胆道结石及肝脏病变的19例患者为研究对象,19例患者因病情需要均采用腹腔镜再次胆道手术联合肝切除术。结果 19例患者中男11例,女8例,年龄30~73岁,平均(42.2±13.1)岁。术前肝功能Child A级15例,B级4例。均顺利完成了腹腔镜下胆道手术联合肝切除术,无中转开腹。肝切除术中Ⅱ+Ⅲ段5例,Ⅱ+Ⅲ+Ⅳ段3例,Ⅶ段2例,Ⅴ段1例,Ⅵ段1例,Ⅵ+Ⅶ段1例,Ⅱ+Ⅲ+Ⅳ+Ⅴ段1例,Ⅴ+Ⅵ段1例,Ⅴ+Ⅵ+Ⅶ段1例,Ⅴ+Ⅷ段1例,Ⅶ+Ⅷ段1例,Ⅴ+Ⅵ+Ⅶ+Ⅷ段1例。19例患者手术时间2.4~5.8h,平均(3.3±0.7)h;术中出血量130~340mL,平均(190.3±55.8)mL;本组患者术程顺利,术中未出现胆道、胃肠道、膈肌等损伤及大出血等并发症。术后患者恢复良好,24~48h后胃肠功能恢复,并能下床活动。患者住院时间6~15d,平均(9.1±1.4)d。术后1例出现胆瘘,其余所有患者无感染、肝衰竭等并发症的发生。结论腹腔镜下再次胆道手术联合肝切除术是安全、可行的,临床疗效满意。Objective To study the clinical effect and safety of laparoscopy in biliary reoperation combined with hepatectomy.Methods Nineteen patients with biliary calculi after biliary operation and hepatic lesions in the Mianyang Municipal Central Hospital from January 2012 to June 2017 served as the research subjects.Nineteen patients adopted laparoscopic biliary reoperation combined with hepatectomy due to the requirements of disease condition.Results Among 19 cases,11 cases were male and 8 cases were female,aged 30-73 years old,with an average age of(42.2±13.1)years old.Preoperative liver function Child grade A was in 15 cases and grade B in 4 case.All cases successfully performed laparoscopic biliary reoperation combined with hepatectomy without conversion to open laparotomy.In the hepatectomy,there were 5 cases ofⅡ+Ⅲsection excision,3 cases ofⅡ+Ⅲ+Ⅳsection,2 cases ofⅦsection,1 case ofⅤsection,1 case ofⅥsection,1 case ofⅥ+Ⅶsection,1 case ofⅡ+Ⅲ+Ⅳ+Ⅴsection,1 case ofⅤ+Ⅵsection,1 case ofⅤ+Ⅵ+Ⅶsection,1 case ofⅤ+Ⅷsection,1 case ofⅦ+Ⅷsection and 1 case ofⅤ+Ⅵ+Ⅶ+Ⅷsection.The surgical time in 19 cases was 2.4-5.8 h,and the mean was(3.3±0.7)h;intraoperative bleeding volume was 130-340 mL,and the average blood volume was(190.3±55.8)mL;the patients in this group had a smooth operation.There were no case appearing the complications such as the damage of biliary tract,gastrointestinal tract and diaphragmatic muscle and massive bleeding.The postoperative recovery was good and the gastrointestinal function was restored after 24-48 h,and could take off-bed activities.The duration of hospitalization was 6-15 d,with an average of(9.1±1.4)d.One case appeared biliary fistula after surgery,and other cases had no complications such as infection,and liver failure,etc.Conclusion Laparoscopic biliary reoperation combined with hepatectomy is safe and feasible with clinical satisfactory effect.

关 键 词：腹腔镜检查 再次胆道手术 肝切除 临床研究 

分 类 号：R657.3[医药卫生—外科学]