腹腔镜下胆管探查术在有开腹胆管手术史的胆管结石患者中的应用  

Application of laparoscopic biliary exploration for biliary stones in patients previously treated with open biliary surgery

作　　者：李毅[1] 周禄科 刘林[1] 杨洁 陈建 谢辉[1] LI Yi;ZHOU Luke;LIU Lin;YANG Jie;CHEN Jian;XIE Hui(Deyang People's Hospital,Deyang 618000,China)

机构地区：[1]德阳市人民医院

出　　处：《山东医药》2019年第29期79-82,共4页Shandong Medical Journal

摘　　要：目的观察有开腹胆管手术史的胆管结石患者行腹腔镜下胆管探查手术的临床效果,并总结操作经验。方法选择45例有开腹胆管手术史的胆管结石患者,均行腹腔镜下胆管探查手术,记录手术时间、术中出血量、术后引流量、术后引流时间及住院时间,观察术后并发症的发生情况,出院后随访患者的预后情况。结果45例患者均成功完成手术,无中转开腹病例。手术时间50~370(290±38)min,术中出血量10~500(210±70)mL,术后引流量0~600(80±45)mL/d,引流时间3~7(5.0±1.2)d,住院时间6~15(7.2±2.1)d。所有患者均未输血,术后无活动性出血、腹腔感染、切口感染等并发症发生。术后6周经胆管镜检查和T管造影确认后拔除T管,术后2个月复查,少数患者术区少量积液,未发现其他并发症。结论对于既往有开腹胆管手术史的胆管结石患者,术者掌握一定的技巧和经验后,腹腔镜下胆管探查术仍具有可行性和安全性。Objective To observe the clinical effect of laparoscopic biliary exploration in patients with biliary stones who had a history of open biliary tract surgery,and to summarize the surgical experience.Methods Forty-five patients with biliary stones who had a history of open biliary tract surgery were treated with laparoscopic biliary exploration.The operation time,intraoperative blood loss,postoperative drainage volume,postoperative drainage time and hospitalization time were recorded.The incidence of postoperative complications was observed.Prognosis of patients was followed up after discharge.Results All 45 patients underwent laparoscopic surgery without conversion to laparotomy.The operation time was 50-370(290±38)min,the intraoperative blood loss was 10-500(210±70)mL,the postoperative drainage volume was 0-600(80±45)mL/d,the drainage time was 3-7(5.0±1.2)d,and the length of hospital stay was 6 to 15(7.2±2.1)d.All patients were not transfused,and no complications such as active bleeding,abdominal infection and wound infection occurred after operation.T-tubes were removed after choledochoscopy and T-tube cholangiography confirmation at 6 weeks after surgery.The patients were re-examined 2 months after surgery.A small number of patients had a small amount of fluid in the operation area and no other complications were found.Conclusion For patients with biliary stones who have had a history of open biliary tract surgery,laparoscopic biliary exploration is still feasible and safe after the surgeon has mastered certain skills and experience.

关 键 词：胆管结石 开腹胆管手术 腹腔镜胆总管切开取石术 

分 类 号：R575.6[医药卫生—消化系统]