直视微创手术技术在复杂肝外胆道手术中的应用

目的将直视微创手术技术应用于复杂肝外胆道手术,降低生理干扰、减少并发症。方法采用直视微创胆道外科手术器械,相对固定的手术步骤、技巧,施行胆囊三角区和胆囊床微创分离,胆囊管、胆囊动脉和胆总管的微创操作技术。结果本组137例复杂肝外胆道手术均在直视微创下完成。胆囊切除手术切口2.5~4.0 cm(平均3.8 cm),胆囊切除+胆总管切开取石、"T"型管引流手术切口4.0~5.0 cm(平均4.5 cm);除1例因胆道损伤于术后第11天行剖腹探查,胆总管空肠Roux-en-Y吻合术以外,其余无胆道损伤、术后出血及死亡病例;术后无痛或微痛。结论直视微创肝外胆道手术技术创伤小、适应证广。

Microinvasive laparoscopy applied in extrahepatic biliary-tract surgery

Objective To evaluate the effect of microinvasive laparoscopy on complicated extrahepatic biliary-tract diseases.Methods Colottriangle and cholecystis-bed were dissected routinely under the guidance of endoscope and cholecystis-tube,cholecystis-artery and billiary-tract were microinvasively operated.Results Cholecystectomy was performed with laparo scope(2.5±4.0 cm) in 137 cases.The average length of the incision was 3.8 cm for 4.0～5.0 cm for cholecystectomy choledocholithotomy and T-tube drainage respectively.Except for one patient needed chole-intestinal anastomosis due to bile duct injury on the 11th day after the procedure,no bile duct injury,death and post-operative hemorrahge was seen.No or slight pain was complained by the patients.Conclusion Microinvasive laparoscopy is applied in extrahepatic biliary-tract surgery with minimal invasion and broad indications,which casts a light on the treatment of complicated extrahepatic biliary-tract diseases.