腹腔镜在再次胆道手术中的临床应用与效果分析

The Application and Analysis of Laparoscopy in Repeated Bile Duct Surgery

目的通过对腹腔镜胆道再次手术病例的回顾性分析,探索该术式在临床中的具体应用方式及手术效果。方法筛选既往有胆道手术史且本次诊断为残余肝胆管结石或肝胆管结石复发患者52例,分别施行三种手术:(1)腹腔镜胆道探查+T管引流;(2)腹腔镜胆道探查+T管引流+肝左外叶切除;(3)腹腔镜胆道探查+胆肠吻合。结果 52例患者没有1例出现中转开腹。术后并发症发生率约10%,包括胆瘘与胃排空延迟,所有并发症均在保守治疗下好转,无1例围手术期死亡,平均住院时间(7±2)d。结论对既往胆道手术史患者再次施行腹腔镜胆道手术不仅对患者创伤小,也安全可行的。

Objective Retrospectively analyze the cases of laparoscopic bile duct reoperation, to explore the clinical ap- plication and effect of the operation. Methods Screening 52 patients had a history of biliary surgery and the diagnosis of residual hepatolithiasis or intrahepatic bile duct stones in patients with recurrent, respectively underwent three surgery：①laparoscopic bile duct exploration and ＋ T tube dralnage;②laparoscopic bile duct exploration and ＋ T tube drainage ＋ liver left Eche;③ LCBD ＋ cholangiojejunostomy. Result No conversion to laparotomy was found in 52 patients. The incidence rate of about 10% postopera- tive complications, including biliary fistula and delayed gastric emptying, all complications were improved after conservative treat- ment, no patients died in the perioperative period, the average hospitalization time was （7 ±2）days amp. Condusions Laparo- scopic biliary tract surgery was minimally invasive, safe and feasible.