腹腔镜胆道探查术40例临床观察
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摘要
目的:探讨腹腔镜胆道探查术临床应用及临床疗效,总结成功经验,在成功的基础上探索新的手术改良方法。
方法:回顾性分析2005年1月至2007年2月吉林大学第一临床医学院普外科所完成40例腹腔镜胆道探查术临床资料。
结果:实施腹腔镜胆道探查手术方式3种:腹腔镜胆总管切开取石T管引流术35例,腹腔镜经胆囊管胆总管探查术2例,腹腔镜胆总管切开探查胆总管一期缝合术1例。15例既往腹部手术史者腹腔镜胆道探查成功率100%,腹腔镜胆道探查术成功38例,成功率95%,中转开腹2例,中转率5%。腹腔镜胆道探查手术时间102.50±34.81min,术后胃肠道恢复时间(肛门排气)2.47±1.13d,术后进食时间2.45±0.89d,术后住院日8.18±3.15d。术后胆汁漏1例(一期缝合),无任何临床症状,未予处置,5天后胆汁漏治愈;术后胆道残余结石2例,均经过T管窦道行胆道镜探查取石术,取净残余结石;无死亡病例。
结论:腹腔镜胆道探查术在治疗胆总管结石合并胆囊结石是安全可行的,疗效是肯定的;开展腹腔镜胆道探查术早期,应以腹腔镜胆总管切开取石T管引流术为主,根据患者病情及术中情况选择不同的手术入路、取石方式是可行的。
Objective: approach clinical application and effect of laparoscopic bile duct exploration, approach better types of operation on the base of our clinical experience exploration. Method:analyze retrospectively clinical data of 40 cases of laparoscopic bile duct exploration the 1st hospital of Ji Lin University, from Jan. 2005 to Feb. 2007. Result: 3 kinds of laparoscopic bile duct exploration: 35 cases of laparoscopic choledochotomy and T-tube drainage, 2 cases of laparoscopic transcystic common bile duct exploration, 1 case of indulgent primary duct closure. achievement ratio of 15 cases of laparoscopic bile duct exploration with history operation on abdominal region is 100%, 38 cases of laparoscopic bile duct exploration,achievement ratio 95%, 2 cases of open operation, open ratio 5%. Operation time 102.50±34.81min, exhaust time 2.47±1.13d, eating time 2.45±0.89d, hospital time after operation 8.18±3.15d. 1 case of bile leakage, 2 cases of retained calculus,no dead case.
Conclusion: in the treatment of common duct stones and cholecyst stones, laparoscopic abile duct exploration is feasible,effective. LCTD should be choosen in the first execution of laparoscopic bile duct exploration. choosing operative route and the way to remove calculus duiring laparoscopic bile duct exploration, according to condition of patients and operation, is feasible.
方法:回顾性分析2005年1月至2007年2月吉林大学第一临床医学院普外科所完成40例腹腔镜胆道探查术临床资料。
结果:实施腹腔镜胆道探查手术方式3种:腹腔镜胆总管切开取石T管引流术35例,腹腔镜经胆囊管胆总管探查术2例,腹腔镜胆总管切开探查胆总管一期缝合术1例。15例既往腹部手术史者腹腔镜胆道探查成功率100%,腹腔镜胆道探查术成功38例,成功率95%,中转开腹2例,中转率5%。腹腔镜胆道探查手术时间102.50±34.81min,术后胃肠道恢复时间(肛门排气)2.47±1.13d,术后进食时间2.45±0.89d,术后住院日8.18±3.15d。术后胆汁漏1例(一期缝合),无任何临床症状,未予处置,5天后胆汁漏治愈;术后胆道残余结石2例,均经过T管窦道行胆道镜探查取石术,取净残余结石;无死亡病例。
结论:腹腔镜胆道探查术在治疗胆总管结石合并胆囊结石是安全可行的,疗效是肯定的;开展腹腔镜胆道探查术早期,应以腹腔镜胆总管切开取石T管引流术为主,根据患者病情及术中情况选择不同的手术入路、取石方式是可行的。
Objective: approach clinical application and effect of laparoscopic bile duct exploration, approach better types of operation on the base of our clinical experience exploration. Method:analyze retrospectively clinical data of 40 cases of laparoscopic bile duct exploration the 1st hospital of Ji Lin University, from Jan. 2005 to Feb. 2007. Result: 3 kinds of laparoscopic bile duct exploration: 35 cases of laparoscopic choledochotomy and T-tube drainage, 2 cases of laparoscopic transcystic common bile duct exploration, 1 case of indulgent primary duct closure. achievement ratio of 15 cases of laparoscopic bile duct exploration with history operation on abdominal region is 100%, 38 cases of laparoscopic bile duct exploration,achievement ratio 95%, 2 cases of open operation, open ratio 5%. Operation time 102.50±34.81min, exhaust time 2.47±1.13d, eating time 2.45±0.89d, hospital time after operation 8.18±3.15d. 1 case of bile leakage, 2 cases of retained calculus,no dead case.
Conclusion: in the treatment of common duct stones and cholecyst stones, laparoscopic abile duct exploration is feasible,effective. LCTD should be choosen in the first execution of laparoscopic bile duct exploration. choosing operative route and the way to remove calculus duiring laparoscopic bile duct exploration, according to condition of patients and operation, is feasible.
引文
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1. 黄志强. 微创外科及外科微创化在本世纪外科的发展. 腹部外科, 2004;17(2):71-73.
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13. 胡三元, 牛军, 姜希宏, 等. 腹腔镜胆总管切开取石术 93 例报告.中华肝胆外科杂志, 1999,5(2):131-132.
14. 邓和军, 李庆东, 冉崇新, 匡毅. 开腹胆道手术器械在腹腔镜胆总管探查术中的临床应用研究[J]. 腹腔镜外科杂志, 2006, 11(1):57-58.
15. 张能维, 等. 腹腔镜胆总管切开取石 T 管引流术[J]. 中国微创外科杂志. 2006,6(9):693-694.
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18. 张雷达, 等. 不同方式的腹腔镜胆道探查术治疗胆总管结石的临床前瞻性研究 [J]. 中国内镜杂志, 2006,12(5).
2. Wills VL, Jorgensen JO, Hunt DR. Role of relaparoscopy in the management of minor bile leakage after laparoscopic cholecyste ctomy. Br J Surg, 2000;87:176-80.
3. Lee CM, Stewart L, Way LW. Postcholecystectomy abdominal bilecollections. Arch Surg, 2000;135:538-542;discussion 542-544.
4. 黄志强. 微创外科及外科微创化在本世纪外科的发展. 腹部外科, 2004;17(2):71-73.
5. 郑民华, 陆爱国, 胡伟国, 等. 腹腔镜胰十二指肠切除术治疗胆总管下段癌 (附一例报告) [J]. 理论与实践, 2005,10 (3):225-228.
6. Philip EH. New techniques for the treatment of common bile duct calculi encountered during laparoscopic cholecystectomy. Problem s in General Surg, 1991,118:38-40.
7. 贾晓巍, 等. 三镜联合治疗急性梗阻性化脓性胆管炎 21 例的体会[J]. 中国现代医学杂志, 2002,12(6):83-84.
8. 张衍祥, 等. 多镜联合应用治疗急性胆管炎临床研究 [J]. 肝胆外科杂志, 2006,18(2):106-107.
9. 李涌, 秦鸣放. 三镜联合治疗 Mirrizi 综合征[J]. 中国中西医结合外科杂志, 2006,12(4):416-417.
10. Nagy A, Brosseuk D, Hemming A, et al. Laparoscopic gastro enterostomyfor duodenal obstruction [J]. Am J Surg, 1995,169 (5):539.
11. 吴瑜. 腹腔镜胆肠吻合术的临床应用 [J]. 中西医结合外科杂志, 2004,10(3):225-226.
12. 罗丁, 陈训如. 腹腔镜超声在腹腔镜胆道手术中的应用 [J]. 中国普外基础与临床杂志, 2005,12(6):543.
13. 罗丁主编. 腹腔镜超声诊断学 [M]. 第1版. 北京: 军事医学科学出版社, 2003:27-87.
14. 胡三元, 牛军, 姜希宏, 等. 腹腔镜胆总管切开取石术 93 例报告. 中华肝胆外科杂志, 1999,5(2):131-132.
15. 陈训如, 田伏洲, 黄大熔, 主编. 微创胆道外科手术学 [M]. 北京: 军事医学科学出版社, 2000.252.
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