胆道手术后复发结石腹腔镜再次手术的可行性及术式探讨

Discussion on the feasibility and operation methods of laparoscopic reoperation for recurrent stones after biliary tract surgical procedure

目的:探讨胆道手术后复发结石再次行腹腔镜手术的可行性及术式选择。方法:回顾分析2014年9月至2019年9月收治的胆道手术后复发结石患者再次手术治疗的临床资料,将胆道手术后再次行开放与腹腔镜胆总管切开取石(开腹组与腹腔镜组)、左肝外叶切除(开腹肝组与腹腔镜肝组)患者的临床资料与疗效进行两两对比分析,总结手术经验。结果:患者均顺利治愈出院。腹腔镜组术中出血量、住院时间、切口感染率优于开腹组,差异有统计学意义(P<0.05)。腹腔镜肝组住院时间、切口感染与胸水发生率优于开腹肝组,差异有统计学意义(P<0.05);两组手术时间差异无统计学意义(P>0.05)。结论:选择合适病例经腹腔镜胆道再次手术安全、有效,可缩短住院时间,减少胆道手术后切口感染,值得在硬件设备齐全、具有熟练腹腔镜手术技巧与丰富开腹胆道手术经验的临床中心推广应用。

Objective:To investigate the feasibility and patterns of laparoscopic reoperation for recurrent cholelithiasis after biliary tract surgery.Methods:Clinical data of patients who suffered from recurrent cholelithiasis after biliary tract surgery and underwent reoperation including laparoscopic and open operation from Sep.2014 to Sep.2019 were retrospectively analyzed.The clinical data and curative effects of open and laparoscopic choledocholithotomy and left lateral hepatectomy after biliary tract surgery were compared and analyzed in pairs,and the operative experience was summarized.Results:All cases were successfully cured and discharged from hospital.The laparoscopic group had a better outcome than the laparotomy group in the volume of intraoperative blood loss,hospital stay and the incidence of incision infection,it showed a statistical difference between the two groups(P<0.05).The laparoscopic left lateral hepatic lobectomy group had better hospital stay,the incidence of incision infection and hydrothorax compared with laparotomy group(P<0.05).There was no significant difference in operative time between the two groups(P>0.05).Conclusions:Choosing the appropriate cases,the repeat biliary surgery by laparoscopic procedure is safe and effective,which can reduce the hospital stay and the incidence of incision infection.It has application value to disseminate by the clinical center which has complete hardware equipment,proficient laparoscopic surgery skills and rich experience of open bile duct surgery.