腹腔镜胆总管十二指肠吻合术84例疗效观察

目的评估腹腔镜胆总管十二指肠吻合术（LCD）在治疗晚期恶性梗阻性黄疸中的临床疗效,总结手术技术经验。方法回顾分析自2011年1月至2012年10月完成LCD的84例患者,总结围手术期临床资料,观察指标包括手术时间、术中出血量、术后住院时间、术后排气时间、术后肝功能恢复情况、术后生存期、住院费用、术后并发症。结果成功实施LCD 83例,中转1例,二次手术8例,平均手术时间（103±43）min,术中平均失血量（20±17）ml,术后平均住院时间（9.0±2.1）d,术后肝功能自（3.4±1.6）d开始明显恢复。术后平均排气时间（2.5±1.2）d,住院平均费用为（28359±4523）元。术后随访2～22个月,术后并发症少。结论 LCD具有明显的快速降黄的临床效果,且与传统的胰腺十二指肠切除术相比,患者住院费用明显降低,手术风险小,保证患者快速康复,随访临床效果良好。

Clinical observations of the effects of laparoscopic choledochoduodenostomies in 84 cases

Objective To summarize the surgery-related factors and patient outcomes of laparoscopic choledochoduodenostomy（LCD） used in our hospital for treatment of advanced malignant obstructive jaundice.Methods Eight-four patients who underwent LCD between January 2011 and October 2012 in the First Hospital of Jilin University were retrospectively enrolled in the study.The perioperative,postoperative and follow-up（range： 2-22 months） clinical data were analyzed for each patient.Results The LCD procedure was completed successfully in 83 cases,with only one case requiring conversion to open cholecystectomy.Eight cases developed complications that required a second operation（jaundice,n=3;postoperative bleeding,n=2;gastrointestinal obstruction,n=3）.The average operation time was（103±43） min.The average postoperative hospital stay was（9.0±2.1） days.The average intraoperative blood loss was（20±17） ml.The average length of time from the surgery to restoration of liver function was（3.4±1.6） days.The postoperative average time to first flatus was（2.5±1.2） days.The average hospitalization cost was（28359±4523） yuan.Conclusion LCD treatment of advanced malignant obstructive jaundice can quickly reduce the level of bilirubin with relatively low-risk of complications.The shorter durations of hospitalization and rehabilitation associated with this procedure make LCD a low-cost,as well as effective,clinical treatment.