腹腔镜针对复杂性胆囊及胆总管结石术中的临床决策及处理技巧  

Clinical decision-making and treatment skills in laparoscopic surgery for complex cholecystoli-thiasis and choledocholithiasis

作　　者：丁维杰 于江 陈斌 王永鑫 步向阳[1] 葛忠[1] DING Wei-jie;YU Jiang;CHEN Bin;WANG Yong-xin;BU Xiang-yang;GE Zhong(Department of Hepatobiliary and Pancreatic Surgery,Qingdao Municipal Hospital Affiliated to Qingdao University,Qingdao,Shandong 266011,China)

机构地区：[1]青岛大学附属青岛市市立医院肝胆胰外科,山东青岛266011

出　　处：《肝胆胰外科杂志》2021年第5期269-273,共5页Journal of Hepatopancreatobiliary Surgery

基　　金：青岛市医疗卫生优秀人才培养项目(青卫科教函字[2017]28号)。

摘　　要：目的探讨腹腔镜术中处理复杂性胆囊结石及胆总管结石的不同方式对手术的影响。方法回顾性分析青岛市市立医院收治的复杂性胆囊及胆总管结石患者136例,总结并归纳术中情况及相对应处理技巧及经验。结果本研究中腹腔粘连病例占全组120例(88.2%),其中炎症粘连73例,手术后粘连47例,术中遵循“宁伤胆囊、远离肝门”的处理原则及相应的处理技巧,98例(81.7%)腹腔粘连患者按照原定手术方式顺利完成,但22例(18.3%)腹腔粘连患者因术中胆总管或胆囊颈管辨别不清、术中发现胆囊癌变等原因施行中转开腹手术。结石嵌顿病例占全组16例(11.8%),包括胆囊颈管及胆总管结石嵌顿,术中应用推挤法、直接取石法、液电碎石等技巧联合应用胆道镜、碎石仪及扩张球囊等设备,手术均在腹腔镜下完成。结论腹腔粘连和结石嵌顿是腹腔镜下复杂性胆囊结石及胆总管结石手术中较常见的困难,相应的术中决策和处理技巧能够为提高患者安全、降低手术风险、减少术后并发症等提供更多的方法与思路。Objective To explore the effects of different handling ways for complex cholecystolithiasis and choledocholithiasis in laparoscopic operation.Methods A retrospective analysis of 136 patients with complex cholecystolithiasis and choledocholithiasis in Qingdao Municipal Hospital was carried out,and the effects of different sudden intraoperative conditions and the corresponding treatment techniques and methods were summarized.Results In this study,the abdominal adhesion patients accounted for 88.2%(120 cases),including 73 cases of inflammatory adhesion and 47 cases of postoperative adhesion.During the operation,the principle of“calming the liver and gallbladder,keeping away from the porta hepatis”and the corresponding treatment skills were followed.98 cases(81.7%)with abdominal adhesion were successfully completed according the original operation plan,while 22 cases(18.3%)were converted to open surgery due to the unclear identification of common bile duct or cystic neck tube during the operation.16 cases(11.8%)in the total group had stone incarceration,including stone incarceration in neck of gallbladder and common bile duct.The techniques of pushing method,direct lithotomy and electrohydraulic lithotripsy were applied during operation,combined with choledochoscopy,lithotripter and balloon dilator.Conclusion Abdominal adhesion and calculus incarceration are the most common difficulties in laparoscopic surgery for complex cholecystolithiasis and choledocholithiasis.The corresponding intraoperative decision-making and management skills can provide more methods and ideas for improving the safety of patients,reducing the risk of surgery and reducing postoperative complications.

关 键 词：腹腔镜手术 胆囊结石 胆总管结石 腹腔粘连 结石嵌顿 

分 类 号：R657.42[医药卫生—外科学]