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中国现代手术学杂志  2018, Vol. 22 Issue (2): 106-108    DOI: 10.16260/j.cnki.1009-2188.2018.02.006
  临床论著 |
减少腹腔镜再次胆道手术并发症的策略(22例临床分析)
毛盛名,何红苏,林建清,肖强,刘岳,陈文哲,倪亚安
广州医科大学附属第六医院肝胆胰腺外科, 清远 511518
Strategies to Reduce Complications of Laparoscopic Reoperation of the Biliary Tracts (22 Cases of ClinicalAnalysis)
MAO Sheng-ming, HE Hong-su, LIN Jian-qing, XIAO Qiang , LIU Yue, CHEN Wen-zhe, NI Ya-an
Department?of?Hepatobiliary?and?Pancreatic?Surgery,?the?Sixth?Hospital?Affiliated?to?Guangzhou?Medical?University,?Qiangyuan?511518,?Guangdong,?China
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摘要 目的 探讨如何提高腹腔镜再次胆道手术的安全性、减少手术并发症的发生率。 方法回顾性总结22例腹腔镜再次胆道手术的临床资料,分析总结如何提高手术安全性。 结果 20例顺利完成腹腔镜再次胆道探查,2例中转开腹手术,中转率为9%。手术时间为(132±35)min,术中失血(93±32)ml,22例患者术中均未输血。所有患者均顺利出院,住院时间为(11.0±4.1)d。共发生并发症2例,并发症发生率为9%。其中胆漏1例,经持续引流后自愈。剑突下穿刺口感染1例,经加强换药后康复。术后随访无胆道狭窄及结石残留发生。 结论 腹腔镜再次胆道手术具有较高的安全性,较开放手术更有优越性。腹腔镜再次胆道手术应由具有丰富腹腔镜操作技术的高年资胆道外科医师进行。术前全面综合分析患者的病史及临床资料、周密的手术计划、耐心精细的手术操作、术中对胆道系统各种解剖标志及变异的准确辨认以及正确把握中转开腹的时机是保证手术安全的主要因素。
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毛盛名,何红苏,林建清,肖强,刘岳,陈文哲,倪亚安
关键词:  腹腔镜手术   再次胆道手术   胆石症   手术并发症   手术技巧    
Abstract: Objective To explore the operative technique to improve the safety of laparoscopic reoperation of the biliary tracts and to reduce the incidence of surgical complications. Methods Laparoscopic reoperation of the biliary tracts was performed on 22 cases of choledocholithiasis. Clinical data of 22 cases of laparoscopic bile duct surgery were reviewed retrospectively. Results Twenty-two cases of laparoscopic cholangiotomy were performed successfully, and two cases converted to open surgery. The conversion rate was 9%. Operation time was (132±35)min. Intraoperative blood loss was (93±32) ml, and no blood transfusion was performed in 22 patients. All patients were discharged successfully, and the length of hospital stay was (11.0±4.1) d. There were 2 cases(9%) suffered from complications, including one case of bile leakage, who was self-healing after 8 days of continuous drainage, and one case of the infection of the subxiphoid puncture. There were no biliary stricture and residual stones after the operation. Conclusions Laparoscopic reoperation of the biliary tracts is safe and effective. The operation should be performed by a high-year biliary surgeon with superior laparoscopic skills. Comprehensive analysis of the history and clinical data of patients with a detailed operation plan, careful operation, intraoperative various anatomical marks of biliary system and accurate recognition and correct grasp of the timing of the conversion of open surgery are the main factors to ensure the safety of the operation.
Key words:  laparoscopy     reoperation     cholelithiasis     complications     surgical skills
               出版日期:  2018-04-26      发布日期:  2018-08-14      期的出版日期:  2018-04-26
ZTFLH:  R657.4  
通讯作者:  毛盛名   
作者简介:  毛盛名,男,49岁,广州医科大学附属第六医院肝胆胰腺外科主任医师。
引用本文:    
毛盛名,何红苏,林建清,肖强,刘岳,陈文哲,倪亚安. 减少腹腔镜再次胆道手术并发症的策略(22例临床分析)[J]. 中国现代手术学杂志, 2018, 22(2): 106-108.
MAO Sheng-ming. Strategies to Reduce Complications of Laparoscopic Reoperation of the Biliary Tracts (22 Cases of ClinicalAnalysis). Chinese Journal of Modern Operative Surgery, 2018, 22(2): 106-108.
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http://www.surgerychina.com/CN/10.16260/j.cnki.1009-2188.2018.02.006  或          http://www.surgerychina.com/CN/Y2018/V22/I2/106
|[1] 胡三元, 陈波, 王可新, 等. 开腹胆道手术后腹腔镜胆道再手术29例分析[J]. 中华普通外科杂志,2007,22(1):46-48.|[2] 陈志良, 任培土, 鲁葆春, 等. 胃大部切除术后患者实施腹腔镜胆囊切除和胆总管探查术的体会[J]. 中华肝胆外科杂志, 2012,18(6):427-429.|[3] 秦红军, 胡仁健, 罗毅, 等. 腹腔镜再次胆道手术治疗肝胆管结石 75 例[J]. 武警医学,2015, 26(1):96-98.|[4] EI-Geidie AA. Is the use of T-tube necessary after laparoscopic choledochotomy?[J]. Gastrointest Surg,2010,14(5):844-888.|[5] 纪洪宇, 朱宏, 刘艳芳, 等. 腹腔镜胆总管探查Ⅰ期缝合术治疗胆总管结石中长期随访报告[J].中国微创外科杂志,2012,12(5):434-435.
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