腹腔镜胆道探查在有上腹部手术史患者中的应用

目的探讨上腹部手术后腹腔镜胆道探查手术的安全性及可行性。方法有上腹部手术史行腹腔镜胆道探查的16例患者(甲组),其中男性7例,女性9例;年龄52～84岁,平均年龄65.4岁。3例合并肝内胆管结石,胆管结石直径大于1.5cm患者10例,结石>2枚者7例。胆总管结石合并胆囊结石患者5例。同期无上腹部手术史行腹腔镜胆道探查243例(乙组),其中男性115例,女性128例;年龄30～81岁,平均年龄56.8岁。甲、乙两组手术方式包括腹腔镜胆囊切除、胆总管探查(LCBDE)、胆总管一期缝合术;LCBDE取石T管引流术(LCTD)。结果甲组手术时间为55～235 min,平均手术时间128.1 min;术中出血量20～300 mL,平均出血量130.6 mL;2例中转开腹。乙组手术时间45～190 min,平均手术时间105.2 min;术中出血量15～120 mL,平均出血量45.2 mL;1例中转开腹。两组术中均无胆道损伤、胃肠道损伤、大出血、气体栓塞等严重并发症发生。结论有上腹部手术史的胆道结石患者行腹腔镜胆道探查,由操作熟练的腹腔镜医师进行手术是安全可行的。

Analysis of laparoscopic operation on bile duct in 16 cases with operation history on upper abdominal region

Objective To discuss the feasibility and safety of laparoscopic operation on bile duct in patients with a history of upper abdominal region.Methods A total of 16 patients with a previous operation on upper abdominal region performed with laparoscopic operation on bile duct(group A) were enrolled,male 7,female 9,aged 52-84 years old,mean age 65.4 years old,of which 3 cases combined with intrahepatic bile duct stones,7 cases had common bile duct > 2 stones,and the diameter of bile duct > 1.5 cm in 10 cases.There were 243 cases without operation history on upper abdominal region performed with laparoscopic operation on bile duct(group B) during the same period,male 115,female 128,aged 30-81 years old,mean aged 56.8 years old.The surgical procedures of group A and B were included: laparoscopic cholecystectomy(LC),laparoscopic common bile duct exploration(LCBDE),one-stage suture and laparoscopic choledocholithotomy and T-tube(LCTD).Results In group A,the operation time were 55-235 minutes,mean time 128.1 minutes,the blood loss were 20-300 mL,mean blood loss was 130.6 mL,and 2 cases performed open surgery.In group B,the operation time were 45-190 minutes,mean time 105.2 minutes,the blood loss were 15-120 mL,mean blood loss was 45.2 mL,and 1 case performed open surgery no bile duct injury,massive hemorrhage and air embolism in 2 groups.Conclusion It is demonstrated that LCBDE by skilled physician for patients with a history of upper abdominal region is minimally invasive and safe.