腹腔镜胆总管探查术在有上腹部手术史胆总管结石患者中的临床应用OA
Clinical application of laparoscopic common bile duct exploration in patients with choledocholithiasis who have a history of upper abdominal surgery
目的 评估腹腔镜胆总管探查术(LCBDE)在有上腹部手术史的胆总管结石患者中应用的安全性和可行性.方法 采用回顾性队列研究设计,纳入2021年1月至2022年12月期间于皖南医学院第一附属医院接受LCBDE治疗的胆总管结石患者96例.根据既往是否有上腹部手术史分为两组:观察组(有上腹部手术史,n=36)和对照组(无上腹部手术史,n=60).比较两组患者的气腹建立方式、胆总管缝合方式、手术时间、术中出血量、中转开腹率、结石清除率、住院时间、术后并发症发生率及其处理方法、术后实验室指标,评估手术效果及安全性.结果 与对照组比较,观察组采用Hasson技术建立气腹的比例更高[38.9%(14/36)vs 1.7%(1/60)],且手术时间更长[150.0(120.0,180.0)min vs 120.0(100.0,145.0)min],差异均有统计学意义(P<0.05);但观察组与对照组患者胆总管一期缝合比例(2.8%vs 8.3%)、术中出血量[15.0(10.0,15.0)mL vs 15.0(10.0,15.0)mL]、住院时间[10.0(8.0,12.5)d vs 11.0(9.0,12.0)d]、中转开腹率(8.3%vs 0)、结石清除率(100.0%vs 96.7%)、术后总并发症发生率(16.7%vs 5.0%)及术后第1天白细胞(WBC)计数[13.8(7.4,16.3)×109/L vs 11.1(8.5,15.2)×109/L]、天冬氨酸氨基转移酶(ALT)[70.5(47.0,105.5)U/L vs 56.5(39.5,96.5)U/L]、丙氨酸氨基转移酶(AST)[(56.3±38.3)U/L vs(53.6±31.7)U/L]、γ-谷氨酸转移酶(GGT)[272.5(126.5,339.3)U/L vs 196.0(86.5,386.0)U/L]差异无统计意义(均P>0.05).结论 LCBDE在既往有上腹部手术史的胆总管结石患者中的临床应用具有较高的安全性和可行性.
Objective To evaluation of the safety and feasibility of laparoscopic common bile duct exploration(LCBDE)in patients with choledocholithiasis who have a history of upper abdominal surgery.Methods A retrospective cohort study was conducted,including 96 patients with choledocholithiasis who underwent LCBDE in the First Affiliated Hospital of Wannan Medical College between January 2021 and December 2022.Patients were divided into two groups based on the history of upper abdominal surgery:the observation group(with a history of upper abdominal surgery,n=36)and the control group(without such a history,n=60).By comparing the two groups in terms of methods for establishing pneumoperitoneum,techniques for common bile duct closure,operation time,intraoperative blood loss,conversion rate,stone clearance rate,hospitalization time,postoperative complications and their management strategies,and postoperative laboratory indicators,a comprehensive evaluation of surgical efficacy and safety was conducted.Results Compared with the control group,the proportion of pneumoperitoneum established using the Hasson technique was significantly higher[38.9%(14/36)vs 1.7%(1/60)],the operation time was longer[150.0(120.0,180.0)min vs 120.0(100.0,145.0)min,P=0.022]in the observation group.However,there was no statistically significant differences in the rate of primary common bile duct closure[(2.8%(1/26)vs 8.3%(5/60)),intraoperative blood loss[15.0(10.0,15.0)mL vs 15.0(10.0,15.0)mL],hospitalization time[10.0(8.0,12.5)d vs 11.0(9.0,12.0)d],conversion rate(8.3%vs 0),stone clearance rate(100.0%vs 96.7%),total postoperative complication rate(16.7%vs 5.0%),or blood test indicators WBC count on the first day after surgery[13.8(7.4,16.3)×109/L vs 11.1(8.5,15.2)×109/L],ALT[70.5(47.0,105.5)U/L vs 56.5(39.5,96.5)U/L],AST[(56.3±38.3)U/L vs(53.6±31.7)U/L],GGT[272.5(126.5,339.3)U/L vs 196.0(86.5,386.0)U/L]between the observation group and control group(all P>0.05).Conclusion For patients with choledocholithiasis who have a history of upper abdominal surgery,LCBDE demonstrates high safety and feasibility in clinical applications,making it worthy of further promotion.
冯之文;张文君;陈晓鹏
皖南医学院第一附属医院(弋矶山医院)肝胆外科,安徽 芜湖 241001皖南医学院第一附属医院(弋矶山医院)肝胆外科,安徽 芜湖 241001皖南医学院第一附属医院(弋矶山医院)肝胆外科,安徽 芜湖 241001
医药卫生
胆总管结石腹腔镜胆总管探查术上腹部手术史
choledocholithiasislaparoscopic common bile duct explorationhistory of upper abdominal surgery
《肝胆胰外科杂志》 2026 (1)
44-48,5
安徽省卫健委重点科研项目(AHWJ2022a016)皖南医学院校级重点项目科研基金(WK2022ZF21).
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