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腹腔镜胆总管探查术治疗既往腹部手术史患者的安全性和可行性。

The safety and feasibility of laparoscopic common bile duct exploration for treatment patients with previous abdominal surgery.

机构信息

Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China.

Department of Emergency and Critical Care Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China.

出版信息

Sci Rep. 2017 Nov 13;7(1):15372. doi: 10.1038/s41598-017-15782-y.

Abstract

The purpose of this study was to evaluate the safety and feasibility of laparoscopic common bile duct exploration (LCBDE) in patients with previous abdominal surgery (PAS). The outcomes were compared in 139 patients (103 upper and 36 lower abdominal surgeries) with PAS and 361 without PAS who underwent LCBDE. The operative time, hospital stay, rate of open conversion, postoperative complications, duct clearance, and blood loss were compared. Patients with PAS had longer operative times (P = 0.006), higher hospital costs (P = 0.043), and a higher incidence of wound complications (P = 0.011) than those without PAS. However, there were no statistically significant in the open conversion rate, blood loss, hospital stay, bile leakage, biliary strictures, residual stones, and mortality between patients with and without PAS (P > 0.05). Moreover, compared with those without PAS, patients with previous upper abdominal surgery (PUAS) had longer operative times (P = 0.005), higher hospital costs (P = 0.030), and a higher open conversion rate (P = 0.043), but patients with previous lower abdominal surgery (PLAS) had a higher incidence of wound complications (P  = 0.022). LCBDE is considered safe and feasible for patients with PAS, including those with PUAS.

摘要

本研究旨在评估既往腹部手术(PAS)患者行腹腔镜胆总管探查术(LCBDE)的安全性和可行性。将 139 例 PAS 患者(103 例上腹部手术,36 例下腹部手术)与 361 例无 PAS 患者行 LCBDE 的结果进行比较。比较手术时间、住院时间、中转开腹率、术后并发症、胆管清除率和出血量。PAS 患者的手术时间更长(P=0.006),住院费用更高(P=0.043),切口并发症发生率更高(P=0.011),但中转开腹率、出血量、住院时间、胆漏、胆管狭窄、残余结石和死亡率与无 PAS 患者相比无统计学差异(P>0.05)。此外,与无 PAS 患者相比,有上腹部手术史(PUAS)的患者手术时间更长(P=0.005),住院费用更高(P=0.030),中转开腹率更高(P=0.043),但有下腹部手术史(PLAS)的患者切口并发症发生率更高(P=0.022)。LCBDE 被认为对 PAS 患者,包括 PUAS 患者是安全可行的。

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