57例有手术史胆管结石患者行腹腔镜胆道手术的临床分析

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1、57例有手术史胆管结石患者行腹腔镜胆道手术的临床分析刘战培(610041成都，中航工业三六三医院普外科)[摘要]目的对有胆道手术史的胆管结石患者行腹腔镜胆道再手术的相关影响因素进行分析。方法回顾性分析57例有胆道手术史的胆管结石患者行腹腔镜胆道再手术的围手术期资料。其中，胆总管结石患者20例，肝胆管结石患者37例。既往行胆囊切除术患者22例，行胆总管探查术患者35例。对手术时间、术中出血量、围手术期并发症相关因素行单因素分析，研究影响手术难度的的主要因素。结果腹腔镜胆道再手术时间及两次手术间期、有无

2、肝胆管结石、肝门移位、肝门部肠粘连、肝切除有关。腹腔镜胆道再手术中出血量与两次手术间期、肝胆管结石、肝切除有关。腹腔镜胆道再手术并发症发生与多次胆道手术史、肝门部及腹壁肠粘连有关。结论腹腔镜胆道再次手术的相关影响因素主要包括肝门部肠粘连、肝门移位和肝叶切除。对有适应症的复发胆管结石患者，腹腔镜胆道再手术仍然是一种安全、可行的治疗选择。[关键词]胆管结石腹腔镜再手术相关因素[中图法分类号]R657.4[文献标志码]AClinicalanalysisof57cholangiolithiasiscases

3、undergonelaparoscopicbiliaryreoperationLiuZhanpei(DepartmentofGeneralSurgery,SanliusanHospital,AVIC,108#,DaosangshuStreet,Chengdu,Sichuan,610041,China)[Abstract]ObjectiveToanalyzetheinfluentialfactorsofthedifficultyinlaparoscopicbiliaryreoperationinpat

4、ientswhohadapreviousbiliaryoperation.MethodsThecontinuousperioperativedataof57patientswereretrospectivelysubjectedinthisstudy,whichincluding20caseswithcommonbileductstone,37caseswithcholangiolithiasis;22casesundergonecholecystectomy,35casesundergoneexp

5、loratorycholedochotomy.Dataasoperationtime,operationbloodlossandperioperativecomlicationswerecollectedandanalyzed.ResultsTheoperationtimeoflaparoscopicbiliaryreoperationwasrelatedtotheintervaltimebetweentwooperations,cholangiolithiasis,dislocationofhep

6、atichilum,adhesioninhepatichilumandlobectomyofliver.Thebloodlosswasrelatedtotheintervaltimebetweenpreviousoperation,cholangiolithiasisandlobectomyofliver.Thecomplicationswererelatedtohistoryofmultiplebiliaryoperations,adhesionofintestineinhepatichiluma

7、ndabdominalwall.ConclusionTheinfluentialfatorsoflaparoscopicbiliaryreoperationaredissectionofintestinaladhesioninhepatichilum,exposureofcommonbileductindislocatedhapatichilumandperformanceofhepaticlobectomy.Laparoscopicbiliaryreoperationisstillasafeand

8、practicaltherapyforbiliarycalculipatientswithbiliaryoperationhistory.[Keywords]biliarycalculi;laparoscopy;reoperation;correlationfactors[通信作者]刘战培E-mail:Liuzhanpei@yahoo.com腹腔镜技术已广泛应用于胆石症患者，腹腔镜胆囊切除术和胆总管探查术已取代传统的开腹手术成为胆石症治疗的标准术式，近年已逐渐开展的腹