腹腔镜再次胆道探查一期缝合治疗胆总管结石的疗效分析

The effect analysis of laparoscopic reoperation in the treatment of bile duct stones

目的探讨腹腔镜再次胆总管切开探查并一期缝合在治疗胆总管结石的可行性及安全性。方法回顾性分析2015年10月~2017年9月本院收治的既往有胆总管切开史并行腹腔镜再次胆总管探查的72例胆总管结石病例资料。结果 65例腹腔镜胆总管切开取石顺利完成(占总例数90.7%),术中中转开腹7例(占总例数9.3%)。围手术期0例死亡;术中出血20~300 ml,平均(65.0±7.2)ml;术中消化道浆肌层损伤3例;手术时间60~200 min,平均(95.0±12.5)min;术后胆漏7例;术后胃肠道功能恢复时间12~40 h,平均(18.0±2.6)h;残余结石1例;切口渗血1例;术后肺部感染3例;术后平均住院时间(4.5±0.5)d;随访3~6个月行彩超或MRCP无胆道狭窄和结石复发。结论在熟练的腹腔镜技术下,腹腔镜再次胆道探查一期缝合术治疗胆总管结石即安全又可行。

Objective To explore the feasibility and safety of laparoscopic reoperation in the treatment of bile duct stones. Methods Aretrospective analysis of the clinical data of 72 cases of bile duct stones who underwent laparoscopic common bile duct exploration in our hospital form Octo- ber 2015 to September 2017. Results To operations were successfully completed in all the 65 cases （by total 90.7%）. While 7 cases were required to open surgery （by total 9.3%）. No one died in perioperative period; the capacity of blood loss was 20-300 ml, the average was （65.0± 12.5）ml; there were 3 cases digestive tract of plasma muscle layer injury; the operation time was 60-200 min, the average was （95.0±12.5）min. After operation, 7 cases of biliaxy leakage; the postoperative gastrointestinal function recovery time was 12-40 h, the average was （18.0±2.6）h, 1 case of residual stones; lcase of incision blood; 3 cases of pulmonary infection; postoperative average hospital days was （4.5±0.5）d; no biliary stricture or recurrence was sure during 3-6 months of follow-up by color Doppler ultrasound or MRCR Conclusion Laparoscopic reoperation in the treatment of bile duct stones is safe and feasible in skilled technology.