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纸质出版:2014
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刘战培.57例有手术史胆管结石患者行腹腔镜胆道手术的临床分析[J].陆军军医大学学报(原第三军医大学学报),2014,36(08):838-841.
Liu Zhanpei.Clinical analysis of 57 cholangiolithiasis cases undergoing laparoscopic biliary reoperation[J].J Amry Med Univ (J Third Mil Med Univ),2014,36(08):838-841.
目的 对有胆道手术史的胆管结石患者行腹腔镜胆道再手术的相关影响因素进行分析。 方法 回顾性分析57例有胆道手术史的胆管结石患者行腹腔镜胆道再手术的围手术期资料。其中,胆总管结石患者20例,肝胆管结石患者37例。既往行胆囊切除术患者22例,行胆总管探查术患者35例。对手术时间、术中出血量、围手术期并发症相关因素行单因素分析,研究影响手术难度的主要因素。 结果 腹腔镜胆道再手术时间与2次手术间期、有无肝胆管结石、肝门移位、肝门部肠粘连、肝切除有关。腹腔镜胆道再手术中出血量与2次手术间期、肝胆管结石、肝切除有关。腹腔镜胆道再手术并发症发生与多次胆道手术史、肝门部及腹壁肠粘连有关。 结论 腹腔镜胆道再次手术的相关影响因素主要包括肝门部肠粘连、肝门移位和肝叶切除。对有适应证的复发胆管结石患者,腹腔镜胆道再手术仍然是一种安全、可行的治疗选择。
Objective To analyze the influential factors in laparoscopic biliary reoperation in patients who had previous biliary operation. Methods The continuous perioperative data of 57 patients were retrospectively analyzed in this study
including 20 cases with common bile duct stone and 37 cases with cholangiolithiasis. Among them
22 cases underwent cholecystectomy
and 35 cases underwent exploratory choledochotomy. Data such as operation time
operation blood loss and perioperative complications were collected and analyzed. Results The operation time of laparoscopic biliary reoperation was related to the interval time between 2 operations
cholangiolithiasis
dislocation of hepatic hilum
adhesion in hepatic hilum and lobectomy of liver. The blood loss was related to the interval time between 2 operations
cholangiolithiasis and lobectomy of liver. The complications were related to the history of multiple biliary operations and the adhesion of intestine in hepatic hilum and abdominal wall. Conclusion The influential factors of laparoscopic biliary reoperation include the dissection of intestinal adhesion in hepatic hilum
exposure of common bile duct in dislocated hepatic hilum and performance of hepatic lobectomy. Laparoscopic biliary reoperation is still a safe and practical therapy for biliary calculi patients with biliary operation history.
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