Department of General Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwai Zhengjie, Nanchang, 330006, Jiangxi, China.
Surg Endosc. 2018 Dec;32(12):4893-4899. doi: 10.1007/s00464-018-6248-3. Epub 2018 Jun 4.
Although patients with previous upper abdominal surgery are no longer considered as a contraindication in laparoscopic surgery, laparoscopic common bile duct exploration (LCBDE) for these patients is still controversial. The aim of this study was to evaluate the safety and effectiveness of LCBDE for patients with previous upper abdominal surgery.
Two hundred and seventeen patients with common bile duct stones who underwent LCBDE in our institution from January 2010 to September 2017 were enrolled in the retrospective study. They were divided into two groups: group A, with previous upper abdominal surgery (n = 50) and group B, without previous upper abdominal surgery (n = 167). Patients' demographic, intraoperative, and postoperative outcomes were retrospectively analyzed.
Group A exhibited a longer operative time compared to group B (179.7 ± 61.5 vs. 156.0 ± 46.8 min, p = 0.014). There was no significant difference in intraoperative blood loss (123.9 ± 99.5 vs. 99.5 ± 84.7 mL, p = 0.087), postoperative hospital stay (7.4 ± 2.6 vs. 6.8 ± 2.3 d, p = 0.193), and overall complication rate (8.0 vs. 5.4%, p = 0.732) between the two groups. There was no mortality in both groups. The initial stone clearance rate showed no significant difference between the two groups (98.0 vs. 98.2%, p = 1.000), and the final stone clearance rate was 100% in both groups (p = 1.000). The stone recurrence rate had no significant difference between the two groups (2.0 vs. 2.4%, p = 1.000). The conversion rate was comparable between group A and group B (6.0 vs. 4.8%, p = 0.718).
LCBDE is a safe and feasible procedure for patients with previous upper abdominal surgery. The keys of this procedure are carefully separating the adhesions and clearly exposing the common bile duct, and using a variety of methods to remove the stones.
尽管既往上腹部手术史不再被视为腹腔镜手术的禁忌证，但对于此类患者行腹腔镜胆总管探查术（LCBDE）仍存在争议。本研究旨在评估 LCBDE 治疗既往上腹部手术患者的安全性和有效性。
回顾性分析 2010 年 1 月至 2017 年 9 月在我院行 LCBDE 的 217 例胆总管结石患者的临床资料。根据是否存在既往上腹部手术史，将患者分为 A 组（既往上腹部手术史，50 例）和 B 组（无既往上腹部手术史，167 例）。比较两组患者的一般资料、术中及术后情况。
A 组患者的手术时间长于 B 组（179.7±61.5 分钟比 156.0±46.8 分钟，p=0.014）。两组患者术中出血量（123.9±99.5 毫升比 99.5±84.7 毫升，p=0.087）、术后住院时间（7.4±2.6 天比 6.8±2.3 天，p=0.193）和总体并发症发生率（8.0%比 5.4%，p=0.732）比较差异均无统计学意义。两组均无死亡病例。两组患者的结石初始清除率比较差异无统计学意义（98.0%比 98.2%，p=1.000），最终结石清除率均为 100.0%（p=1.000）。两组患者的结石复发率比较差异无统计学意义（2.0%比 2.4%，p=1.000）。A 组和 B 组的中转开腹率比较差异无统计学意义（6.0%比 4.8%，p=0.718）。
LCBDE 是治疗既往上腹部手术患者的一种安全、可行的方法。手术的关键是仔细分离粘连，清晰显露胆总管，并采用多种方法取石。
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