上腹部手术史二次行腹腔镜治疗胆总管结石的临床经验与技巧(1)
DOI：10.16662/j.cnki.1674-0742.2017.25.020
[摘要] 目的 探讨有过上腹部手术史患者二次行腹腔镜治疗胆总管结石的临床技巧，为临床应用提供经验。 方法 方便选用2013年7月—2016年7月该院进行二次行腹腔镜治疗胆总管结石患者60例，2016年7月—2017年7月淮安市第一人民医院定点协作二次行腹腔镜治疗胆总管结石患者40例作为研究对象，其中男性患者53例，女性患者为47例，所有研究对象年龄在23～71岁之间，随机分为对照组和实验组各50例，对照组患者采取传统开腹手，实验组患者均行二次行腹腔镜治疗胆总管结石手术，术后观察患者手术指标、康复进程以及术后不良事件的发生率。结果对照组和实验组患者均顺利完成整个手术过程。患者手术过程中各项生命体征较平稳，对照组患者手术时间在84～156 min之間，平均手术时间为(132±35.00)min；所有患者术中出血量为43～92 mL之间，平均术中出血量为(63±18.00)mL。术后胃肠道功能恢复时间为(42.16±6.09)h。所有患者平均住院时间为(10.32±2.60)d。实验组患者手术时间在69～135 min之间，平均手术时间为(107±26.00)min；所有患者术中出血量为13～78 mL之间，平均术中出血量为(41±16.00)mL。术后胃肠道功能恢复时间为(25.32±3.12)h。所有患者平均住院时间为(7.4±1.60)d。对照组和实验组相比，差异有统计学意义(P<0.05)。对照组出现术后镇痛9例、胆道狭窄5例、术后胆瘘4例、切口感染6例。实验组患者术后出现术后镇痛5例、胆道狭窄2例、术后胆瘘1例、切口感染2例。对照组和实验组相比，差异有统计学意义(P< 0.05)。结论 既往有上腹部手术史的患者二次行腹腔镜治疗胆总管结石是可行的，要做好术前影像学评估，掌握好术中技术操作难点，判断好术中结石以及Oddi 括约肌功能，及时做好并发症的预防以及处理。
[关键词] 上腹部手术史；腹腔镜；胆总管结石；临床经验
[中图分类号] R657 [文献标识码] A [文章编号] 1674-0742(2017)09(a)-0020-04
Clinical Experience and Skills of the Twice Laparoscopic Treatment for Choledocholithiasis of Upper Abdominal Surgery
JIANG Hai-jun1， CHEN Ya2， CHENG Huan-huan1， QI Fu-zhen2
1.Department of General Surgery， Baoying Traditional Chinese Medicine Hospital， Yangzhou， Jiangsu Province， 225800 China； 2.Department of Hepatobiliary and Pancreatic Surgery， Huai’an First People’s Hospital， Huai’an， Jiangsu Province， 223300 China
[Abstract] Objective This paper tries to investigate the clinical skills of the twice laparoscopic treatment for choledocholithiasis of upper abdominal surgery and to provide experience for the clinical application. Methods 60 cases underwent twice laparoscopic treatment for choledochlithiasis from July 2013 to July 2016 in this hospital were convenient selected， 40 cases from July 2016 to July 2017 underwent laparoscopic treatment were selected as the research objects， including 53 cases of male patients， 47 female patients， all subjects were between the ages of 23 and 71， and were randomly divided into the control group and the experimental group with 50 cases in each group， the control group took the traditional open surgery， patients in the experimental group underwent twice laparoscopic treatment for choledochlithiasis surgery， the operation indexes of patients with postoperative rehabilitation process and the incidence of postoperative adverse events were observed. Results Both of the control group and the experimental group successfully completed the surgery. During the surgery the patients vital signs were stable， the operation time in the control group was between 84 ～ 156 min， the average operation time was (132±35.00)min； the amount of bleeding in all patients was between 43 ～ 92 mL， the average amount of bleeding was (63±18.00)mL；postoperative gastrointestinal function recovery time was (42.16±6.09)h； the average hospitalization time was (10.32±2.6)d. The operation time in the experimental group was between 69 ～ 135 minutes， the average operation time was (107±26.00)min； the amount of bleeding in all patients was between 13 ～ 78 ml， the average amount of bleeding was (41±16.00)mL； gastric intestinal function recovery time was(25.32±3.12)h； the average hospitalization time was(7.4±1.60)d. There was significant difference between the control group and the experimental group(P<0.05). 9 cases of postoperative analgesia in the control group， biliary stricture of 5 cases， 4 cases of biliary fistula， 6 cases of incision infection； 5 cases of postoperative analgesia in the experimental group after operation， 2 cases of biliary stenosis， 1 case of biliary fistula after surgery， 2 cases of incision infection， so the difference between the control group and the experimental group was significant(P<0.05). Conclusion For those who have prior history of upper abdominal surgery， the twice laparoscopic treatment is feasible， the preoperative imaging evaluation should be conducted， the technical difficulties in operating shall be mastered in operation， the calculus in operation and the function of sphincter of Oddi should be determined， timely prevention and processing of complications should be carried out., 百拇医药(姜海军 陈亚 程焕焕 祁付珍)
[摘要] 目的 探讨有过上腹部手术史患者二次行腹腔镜治疗胆总管结石的临床技巧，为临床应用提供经验。 方法 方便选用2013年7月—2016年7月该院进行二次行腹腔镜治疗胆总管结石患者60例，2016年7月—2017年7月淮安市第一人民医院定点协作二次行腹腔镜治疗胆总管结石患者40例作为研究对象，其中男性患者53例，女性患者为47例，所有研究对象年龄在23～71岁之间，随机分为对照组和实验组各50例，对照组患者采取传统开腹手，实验组患者均行二次行腹腔镜治疗胆总管结石手术，术后观察患者手术指标、康复进程以及术后不良事件的发生率。结果对照组和实验组患者均顺利完成整个手术过程。患者手术过程中各项生命体征较平稳，对照组患者手术时间在84～156 min之間，平均手术时间为(132±35.00)min；所有患者术中出血量为43～92 mL之间，平均术中出血量为(63±18.00)mL。术后胃肠道功能恢复时间为(42.16±6.09)h。所有患者平均住院时间为(10.32±2.60)d。实验组患者手术时间在69～135 min之间，平均手术时间为(107±26.00)min；所有患者术中出血量为13～78 mL之间，平均术中出血量为(41±16.00)mL。术后胃肠道功能恢复时间为(25.32±3.12)h。所有患者平均住院时间为(7.4±1.60)d。对照组和实验组相比，差异有统计学意义(P<0.05)。对照组出现术后镇痛9例、胆道狭窄5例、术后胆瘘4例、切口感染6例。实验组患者术后出现术后镇痛5例、胆道狭窄2例、术后胆瘘1例、切口感染2例。对照组和实验组相比，差异有统计学意义(P< 0.05)。结论 既往有上腹部手术史的患者二次行腹腔镜治疗胆总管结石是可行的，要做好术前影像学评估，掌握好术中技术操作难点，判断好术中结石以及Oddi 括约肌功能，及时做好并发症的预防以及处理。
[关键词] 上腹部手术史；腹腔镜；胆总管结石；临床经验
[中图分类号] R657 [文献标识码] A [文章编号] 1674-0742(2017)09(a)-0020-04
Clinical Experience and Skills of the Twice Laparoscopic Treatment for Choledocholithiasis of Upper Abdominal Surgery
JIANG Hai-jun1， CHEN Ya2， CHENG Huan-huan1， QI Fu-zhen2
1.Department of General Surgery， Baoying Traditional Chinese Medicine Hospital， Yangzhou， Jiangsu Province， 225800 China； 2.Department of Hepatobiliary and Pancreatic Surgery， Huai’an First People’s Hospital， Huai’an， Jiangsu Province， 223300 China
[Abstract] Objective This paper tries to investigate the clinical skills of the twice laparoscopic treatment for choledocholithiasis of upper abdominal surgery and to provide experience for the clinical application. Methods 60 cases underwent twice laparoscopic treatment for choledochlithiasis from July 2013 to July 2016 in this hospital were convenient selected， 40 cases from July 2016 to July 2017 underwent laparoscopic treatment were selected as the research objects， including 53 cases of male patients， 47 female patients， all subjects were between the ages of 23 and 71， and were randomly divided into the control group and the experimental group with 50 cases in each group， the control group took the traditional open surgery， patients in the experimental group underwent twice laparoscopic treatment for choledochlithiasis surgery， the operation indexes of patients with postoperative rehabilitation process and the incidence of postoperative adverse events were observed. Results Both of the control group and the experimental group successfully completed the surgery. During the surgery the patients vital signs were stable， the operation time in the control group was between 84 ～ 156 min， the average operation time was (132±35.00)min； the amount of bleeding in all patients was between 43 ～ 92 mL， the average amount of bleeding was (63±18.00)mL；postoperative gastrointestinal function recovery time was (42.16±6.09)h； the average hospitalization time was (10.32±2.6)d. The operation time in the experimental group was between 69 ～ 135 minutes， the average operation time was (107±26.00)min； the amount of bleeding in all patients was between 13 ～ 78 ml， the average amount of bleeding was (41±16.00)mL； gastric intestinal function recovery time was(25.32±3.12)h； the average hospitalization time was(7.4±1.60)d. There was significant difference between the control group and the experimental group(P<0.05). 9 cases of postoperative analgesia in the control group， biliary stricture of 5 cases， 4 cases of biliary fistula， 6 cases of incision infection； 5 cases of postoperative analgesia in the experimental group after operation， 2 cases of biliary stenosis， 1 case of biliary fistula after surgery， 2 cases of incision infection， so the difference between the control group and the experimental group was significant(P<0.05). Conclusion For those who have prior history of upper abdominal surgery， the twice laparoscopic treatment is feasible， the preoperative imaging evaluation should be conducted， the technical difficulties in operating shall be mastered in operation， the calculus in operation and the function of sphincter of Oddi should be determined， timely prevention and processing of complications should be carried out., 百拇医药(姜海军 陈亚 程焕焕 祁付珍)