腹腔镜再次胆道手术治疗胆总管结石的外科技巧与应用价值

发布时间：2019-04-27 05:51

【摘要】：目的探讨腹腔镜再次胆道手术治疗胆总管结石的手术技巧。方法回顾性分析我院2011年1月~2015年12月54例既往有胆道手术史的胆总管结石行腹腔镜下胆总管切开取石的临床资料,术中通过穿刺孔选择、肝脏面显露、胆总管显露确认途径,行胆道镜取石T管引流术或胆总管一期缝合术。结果 52例腹腔镜手术均成功,中转开腹2例。术中出血量40~150 ml,平均70 ml;手术时间75~180 min,平均120 min;术后胃肠功能恢复时间24~48 h,(27±13)h。术中十二指肠穿孔性损伤1例,术后发生胆漏2例,残余结石2例,分别采用腹腔镜下缝合修补、延长拔腹腔引流管时间、经窦道胆道镜取石等方法处理。术后住院时间6~9 d,(7.0±1.5)d。54例随访3~24个月,平均14.8月,均恢复良好,无胆道狭窄、结石复发。结论掌握熟练的腹腔镜手术方法和分离术区粘连技巧,腹腔镜再次胆道手术治疗胆总管结石是安全可行的。
[Abstract]:Objective to explore the surgical techniques of laparoscopic reoperation for choledocholithiasis. Methods the clinical data of 54 cases of choledocholithiasis undergoing laparoscopic choledocholithiasis from January 2011 to December 2015 in our hospital were retrospectively analyzed. Choledochoscopy and T-tube drainage or primary suture of common bile duct were performed. Results all 52 cases of laparoscopic surgery were successful, and 2 cases were converted to laparotomy. The average operative time was 75-180 min, (40-150 ml,). The recovery time of gastrointestinal function was 24-48 hours (27 卤13) hours after operation, and the average time of gastrointestinal function recovery was 24-48 hours (27 卤13) hours. One case of duodenal perforation injury, 2 cases of bile leakage and 2 cases of residual stones were treated by laparoscopic suture repair, prolonging the time of abdominal drainage tube extraction and stone extraction by sinus choledochoscope, etc. The results were as follows: 1 case of duodenal perforation injury, 2 cases of postoperative bile leakage and 2 cases of residual stones. 54 patients (7.0 卤1.5) d.54 patients were followed up for 3 months for 24 months (mean 14.8 months). There was no bile duct stricture and stone recurrence. Conclusion Laparoscopic reoperation is safe and feasible to treat choledocholithiasis.
【作者单位】：洛阳市第六人民医院普外科;
【分类号】：R657.42

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