开腹胆系术后腹腔镜胆系再手术

目的 :探讨开腹胆系手术后腹腔镜胆系再手术的疗效。方法 :2 7例开腹胆系术后胆系病变患者 ,应用腹腔镜在直视下建立气腹 ,分离钩、超声刀交替分离腹腔、肝下粘连 ,解剖残余胆囊、胆道 ,术中胆道造影 ,纠正解剖路线和术前诊断 ,在腹腔镜下行残留胆囊切除、胆道探查、取石、胆道Ⅰ期缝合、T管引流与胆肠吻合术。结果 :在腹腔镜下 2 7例的残留胆囊切除、胆道解剖、术中造影均获成功 ,排除胆道肿瘤 2例 ,完成LC7例 ,探查胆道、取石、胆道Ⅰ期缝合 4例 ,T管引流 13例 ,胆总管 十二指肠吻合 3例 ,其中老年胆总管囊肿 1例、老年胆道下段恶性肿瘤 2例 ,胆总管狭窄胆肠Roux en Y吻合术 1例 ,胆道肿瘤 2例存活 4 ～13个月 ,余者随访 1～37个月无近远期手术并发症发生。结论 :开腹胆系术后腹腔镜下胆系再手术安全有效 ,但对医师的手术技巧要求较高 ,应根据病情设计不同的手术方式。

The laparoscopic biliary system reoperation of the postoperation

Objective:To investigate the effect of the laparoscopic for operation biliary system after open operation.Methods:27 cases with biliary system trouble after biliary system operation were treated by laparoscopy.During operation,abdominal and hepatic adhesion were separated with ultrasonic scalpel or lony hook electrode,so the authors could find postoperative remained gallbladder and bile ducts and gave interoperative cholangingraphly(IOC).By these methods,the anatomy way and preoperative diagnosis were corrected,and succeeded in laparoscopic operations of LC,LCHT,primary duct closure,"T"tube drainage,biliary-enterostomy.Results:27 cases were succeedly separated the postoperative remained gallbladder,biliary ducts and IOC by Laparoscopy.2 cases with biliary duct tumor were excluded.LC 7 cases,primary duct closure 4 cases, "T"tube drainage 13 cases,biliary duct duodenum limb 3 cases in these cases,1 case with congenitial choledochal cyst and 2 cases with choledochal tumor. 1 case with bile duct structure after operation was performed the operation of laparoscopic biliary duct-intestinal Roux-en-Y anastomosis.Followed-up 1-37 months,there were no complication except for 2 cases with biliary duct tumor lived for 4-13 months.Conclusions:The laparoscopic operation for biliary system after open operation is effective and safety,but it requires the higher skill than others,and different operative methods according to cases must be designed.