Yun Keong Won, Ahn Young Joon, Lee Hae Won, Jung In Mok, Chung Jung Kee, Heo Seung Chul, Hwang Ki-Tae, Ahn Hye Seong
Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea. ; Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
Korean J Hepatobiliary Pancreat Surg. 2012 Nov;16(4):154-9. doi: 10.14701/kjhbps.2012.16.4.154. Epub 2012 Nov 30.
BACKGROUNDS/AIMS: We aimed to to evaluate the feasibility of laparoscopic common bile duct exploration (LCBDE) in patients with previous upper abdominal surgery. METHODS: Retrospective analysis was performed on data from the attempted laparoscopic common bile duct exploration in 44 patients. Among them, 5 patients with previous lower abdominal operation were excluded. 39 patients were divided into two groups according to presence of previous upper abdominal operation; Group A: patients without history of abdominal operation. (n=27), Group B: patients with history of upper abdominal operation. Both groups (n=12) were compared to each other, with respect to clinical characteristics, operation time, postoperative hospital stay, open conversion rate, postoperative complication, duct clearance and mortality. RESULTS: All of the 39 patients received laparoscopic common bile duct exploration and choledochotomy with T-tube drainage (n=38 [97.4%]) or with primary closure (n=1). These two groups were not statistically different in gender, mean age and presence of co-morbidity, mean operation time (164.5±63.1 min in group A and 134.8±45.2 min in group B, p=0.18) and postoperative hospital stay (12.6±5.7 days in group A and 9.8±2.9 days in group B, p=0.158). Duct clearance and complication rates were comparable (p>0.05). 4 cases were converted to open in group A and 1 case in group B respectively. In group A (4 of 27 (14.8%) and 1 of 12 (8.3%) in group B, p=0.312) Trocar or Veress needle related complication did not occur in either group. CONCLUSIONS: LCBDE appears to be a safe and effective treatment even in the patients with previous upper abdominal operation if performed by experienced laparoscopic surgeon, and it can be the best alternative to failed endoscopic retrograde cholangiopancreatography for difficult cholelithiasis.
背景/目的:我们旨在评估既往有上腹部手术史的患者行腹腔镜胆总管探查术(LCBDE)的可行性。 方法:对44例尝试行腹腔镜胆总管探查术患者的数据进行回顾性分析。其中,排除5例既往有下腹部手术史的患者。39例患者根据既往是否有上腹部手术史分为两组;A组:无腹部手术史患者(n = 27),B组:有上腹部手术史患者(n = 12)。比较两组患者的临床特征、手术时间、术后住院时间、中转开腹率、术后并发症、胆管清除情况及死亡率。 结果:39例患者均接受了腹腔镜胆总管探查术及胆总管切开术,其中38例(97.4%)置T管引流,1例一期缝合。两组患者在性别、平均年龄、合并症情况方面无统计学差异,平均手术时间(A组164.5±63.1分钟,B组134.8±45.2分钟,p = 0.18)及术后住院时间(A组12.6±5.7天,B组9.8±2.9天,p = 0.158)也无统计学差异。胆管清除率及并发症发生率相当(p>0.05)。A组和B组分别有4例和1例中转开腹。A组27例中有4例(14.8%)、B组12例中有1例(约8.3%)发生与套管针或韦氏针相关的并发症,两组发生率无统计学差异(p = 0.312)。 结论:如果由经验丰富的腹腔镜外科医生操作,即使是既往有上腹部手术史的患者,LCBDE似乎也是一种安全有效的治疗方法,对于困难性胆石症患者,它可能是内镜逆行胰胆管造影失败后的最佳替代方案。
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