单中心23年胆道外科腹腔镜手术的围手术期安全性分析

目的分析解放军总医院23年间收治胆道外科行腹腔镜手术患者的围手术期情况，探讨腹腔镜手术在胆道外科应用中的安全性。 方法根据相关纳入标准回顾性分析解放军总医院胆道外科1992年4月至2014年12月期间收治的连续11 419例腹腔镜手术患者的临床资料，进而分析其围手术期并发症发生和严重程度情况。选取同期行开腹手术的患者资料作为对照进行对比分析，比较两组患者之间围手术期和术后并发症情况。 结果(1)解放军总医院胆道外科1992年4月至2014年12月23年间收治的行腹腔镜手术患者共11 419例，占同期胆道外科手术患者的56.33%。(2)在所有患者中，围手术期死亡患者2例，病死率为0.02%；发生并发症患者43例，并发症发生率为0.38%。在所有并发症中，最常见的依次为胆瘘、切口感染和腹腔感染，发生率分别为0.18%、0.05%和0.05%，其中60.42%的并发症为Ⅱ级并发症，V级致死性并发症占4.17%。(3)腹腔镜手术并发症患者中构成比最高的疾病是胆囊良性疾病和肝外胆管结石，分别占58.14%和25.58%。(4) 对于胆囊良性疾病而言，腹腔镜手术的术中出血量、手术时间、术后住院时间、并发症发生率、病死率均优于开腹手术[(15.6±26.1)ml、(1.1±0.5)h、(2.1±1.8)d、25例(0.22%)、1例(0.01%)] vs [(136.1±168.2)ml、(1.7±0.8)h、(9.8±5.4)d、25例(0.22%)、80例(4.42%)](P<0.01)。对于肝外胆管结石患者而言，腹腔镜手术的术中出血量、术后住院时间和并发症发生率方面优于开腹手术[(44.4±46.1)ml、(5.4±5.7)h、11例(3.24%)] vs [(142.5±125.0)ml、(13.0±9.1)h、(9.8±5.4)d、84例(13.29%)](P<0.01)。 结论随着腹腔镜技术在胆道外科的推广和发展，其在胆囊良性疾病和肝外胆管结石中的应用最为广泛，围手术期效果明显优于开腹手术。

Safety analysis of perioperative period of biliary laparoscopic surgery among 23 years in a single center

ObjectiveTo analyze the data of perioperative period of patients with biliary laparoscopic surgery during the 23 years of the PLA General Hospital, and to explore the safety of laparoscopic surgery in biliary surgery. MethodsWe retrospectively analyzed the clinical data of 11 419 consecutive patients underwent biliary laparoscopic surgery in PLA General Hospital between Apr. 1992 and Dec. 2014 according to the inclusion criteria. The data of biliary open surgery patients in the same period were selected as the control group to compare, and the postoperative complications of the two groups were analyzed. Results(1) From Apr. 1992 to Dec. 2014, 11 419 patients underwent laparoscopic surgery in the General Hospital of PLA among 23 years, and accounted for 56.33% of patients with biliary surgery. (2) In all patients, 2 patients died in the perioperative period, the mortality rate was 0.02%, 43 cases occurred complications, and the complication rate was 0.38%. The most common complications were biliary fistula, wound infection and abdominal infection. The incidence rate were 0.18%, 0.05% and 0.05%. Among the complications, 60.42% were Grade II compications and 4.17% were Grade V. (3)The most common diseases with complication after laparoscopic surgery were gallbladder benign disease and extrahepatic bile duct stones, accounted for 58.14% and 25.58%. (4) For gallbladder benign disease patients, the intraoperative bleeding volume, operation time, hospitalization days, complication rate, mortality rate of laparoscopic surgery were superior to open surgery[(15.6±26.1)ml、(1.1±0.5)h、(2.1±1.8)d、25 patients (0.22%)、1 patient (0.01%)] vs [(136.1±168.2)ml、(1.7±0.8)h、(9.8±5.4)d、25 patients (0.22%)、80 patients (4.42%)](P<0.01). For extrahepatic bile duct stones patients, the intraoperative bleeding volume, hospitalization days and complication rate of laparoscopic surgery were superior to open surgery [(44.4±46.1)ml、(5.4±5.7)h、11 patients (3.24%)] vs [(142.5±125.0)ml、(13.0±9.1)h、(9.8±5.4)d、84 patients (13.29%)] (P<0.01). ConclusionsWith the development of laparoscopic technology in biliary surgery, it is the most widely used in the gallbladder benign disease and extrahepatic bile duct stones, and the perioperative effect is better than that of the open surgery.