术前评估及手术策略对腹腔镜再次胆道手术安全性的影响  

The influence of the preoperative assessment and surgical strategy of laparoscopic biliary tract reoperation on the surgical safety

作　　者：石勇平 王茜 柴新群[1] SHI Yong-ping;WANG Xi;CHAI Xin-qun(Department of Hepatobiliary Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院肝胆外科,武汉430022

出　　处：《肝胆外科杂志》2022年第1期24-28,共5页Journal of Hepatobiliary Surgery

摘　　要：目的探讨术前评估及手术策略对腹腔镜再次胆道手术安全性的影响.方法回顾性分析我院肝胆外科2015年1月到2021年1月,75例腹腔镜再次胆道手术病人的临床资料.结果75例再次胆道手术,男28例,女47例,平均年龄59.4±14.2岁.肝功能Child-pugh评级:A级68例,B级4例,C级3例.两次胆道手术62例,三次胆道手术10例,四次及以上胆道手术3例.术后并发症:肺部感染者5例,胆漏及腹腔感染者3例,经积极护肝、抗感染等保守治疗后好转;腹腔出血1例,经再次剖腹探查止血后好转.75例腹腔镜再次胆道手术,行中转开腹手术者9例,中转开腹率12.0%.围术期死亡2例,死亡率2.7%.结论通过充分的术前评估、选择合适的手术方式、适时的中转手术以及对术后并发症的及时发现及处理,腹腔镜再次胆道手术是安全可行的.Child-pugh评分并不能准确反映再次胆道手术病人的肝脏储备功能,这可能与手术不切除肝脏有关.Objective To investigate the influence of the preoperative assessment and surgical strategy of laparoscopic biliary tract reoperation on the surgical safety.Methods Fhe clinical data of 75 patients undergoing laparoscopic biliary tract reoperation in the department of hepatobiliary Surgery in our hospital from January 2015 to January 2021 were retrospectively analyzed.Results Out of the 75 cases,28 were male and 47 were female,with an average age of 59.4±14.2 years,68 were in Child-pugh glass A,4 were in Child-pugh class B,and 3 were in class C.62 cases of biliary tract surgery were performed twice,three times in 10 cases of biliary tract surgery,four or more biliary operations were performed in 3 cases.Postoperative pulmonary infection occurred in 5 cases,bile leak and abdominal infection occurred in 3 cases,and all of them turned well after active liver protection and anti-infective treatment.1 case of patients developed with abdominal bleeding and performed operation to stop blood again.??Among 75 cases of laparoscopic biliary tract reoperation,9 cases were converted to open operation,the rate of conversion to open operation was 12%,and 2 cases died during perioperative period,the mortality rate was 2.7%.Conclusion After adequate preoperative assessment,timely convertion to operation and management of postoperative complications,laparoscopic biliary tract reoperation is safe and feasible.Child-pugh score for patients undergoing biliary tract reoperation cannot accurately reflect the liver reserve function,which may be related to the absence of intraoperative hepatectomy.

关 键 词：再次胆道手术 术前评估 手术策略 安全性 

分 类 号：R657.4[医药卫生—外科学]