腹腔镜手术治疗胆结石或胆总管结石：对于有上腹部手术史的患者而言，是一种稳定、安全且可行的手术策略。
Laparoscopic surgery for gallstones or common bile duct stones: A stably safe and feasible surgical strategy for patients with a history of upper abdominal surgery.
作者信息
Yang Shaojie, Wu Shuodong, Dai Wanlin, Pang Liwei, Xie Yaofeng, Ren Tengqi, Zhang Xiaolin, Bi Shiyuan, Zheng Yuting, Wang Jingnan, Sun Yang, Zheng Zhuyuan, Kong Jing
机构信息
Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China.
Innovation Institute of China Medical University, Shenyang, China.
出版信息
Front Surg. 2022 Sep 30;9:991684. doi: 10.3389/fsurg.2022.991684. eCollection 2022.
BACKGROUNDS/AIMS: A history of upper abdominal surgery has been identified as a relative contraindication for laparoscopy. This study aimed to compare the clinical efficacy and safety of laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) in patients with and without previous upper abdominal surgery.
METHODS
In total, 131 patients with previous upper abdominal surgery and 64 without upper abdominal surgery underwent LC or LCBDE between September 2017 and September 2021 at the Shengjing Hospital of China Medical University. Patients with previous upper abdominal surgery were divided into four groups: group A included patients with previous right upper abdominal surgery who underwent LC ( = 17), group B included patients with previous other upper abdominal surgery who underwent LC ( = 66), group C included patients with previous right upper abdominal surgery who underwent LCBDE ( = 30), and group D included patients with previous other upper abdominal surgery who underwent LCBDE ( = 18). Patient demographics and perioperative outcomes were retrospectively analyzed.
RESULTS
The preoperative liver function indexes showed no significant difference between the observation and control groups. For patients who underwent LC, groups A and B had more abdominal adhesions than the control group. One case was converted to open surgery in each of groups A and B. There was no statistical difference in operation time, estimated blood loss, postoperative hospital stay, and drainage volume. For patients who underwent LCBDE, groups C and D had more estimated blood loss than the control group (group C, 41.33 ± 50.84 vs. 18.97 ± 13.12 ml, = 0.026; group D, 66.11 ± 87.46 vs. 18.97 ± 13.12 ml, = 0.036). Compared with the control group, group C exhibited longer operative time (173.87 ± 60.91 vs. 138.38 ± 57.38 min, = 0.025), higher drainage volume (296.83 ± 282.97 vs. 150.83 ± 127.04 ml, = 0.015), and longer postoperative hospital stay (7.97 ± 3.68 vs. 6.17 ± 1.63 days, = 0.021). There was no mortality in all groups.
CONCLUSIONS
LC or LCBDE is a safe and feasible procedure for experienced laparoscopic surgeons to perform on patients with previous upper abdominal surgery.
背景/目的：上腹部手术史已被视为腹腔镜检查的相对禁忌证。本研究旨在比较有或无上腹部手术史患者行腹腔镜胆囊切除术（LC）和腹腔镜胆总管探查术（LCBDE）的临床疗效及安全性。
方法
2017年9月至2021年9月期间，在中国医科大学附属盛京医院，共有131例有上腹部手术史的患者和64例无上腹部手术史的患者接受了LC或LCBDE。有上腹部手术史的患者分为四组：A组为有右上腹手术史且接受LC的患者（n = 17），B组为有其他上腹部手术史且接受LC的患者（n = 66），C组为有右上腹手术史且接受LCBDE的患者（n = 30），D组为有其他上腹部手术史且接受LCBDE的患者（n = 18）。对患者的人口统计学资料和围手术期结局进行回顾性分析。
结果
术前肝功能指标在观察组和对照组之间无显著差异。接受LC的患者中，A组和B组的腹腔粘连比对照组更多。A组和B组各有1例转为开腹手术。手术时间、估计失血量、术后住院时间和引流量方面无统计学差异。接受LCBDE的患者中，C组和D组的估计失血量比对照组更多（C组，41.33±50.84 vs. 18.97±13.12 ml，P = 0.026；D组，66.11±87.46 vs. 18.97±13.12 ml，P = 0.036）。与对照组相比，C组手术时间更长（173.87±60.91 vs. 138.38±57.38 min，P = 0.025），引流量更高（296.83±282.97 vs. 150.83±127.04 ml，P = 0.015），术后住院时间更长（7.97±3.68 vs. 6.17±1.63天，P = 0.021）。所有组均无死亡病例。
结论
对于有经验的腹腔镜外科医生而言，LC或LCBDE对有上腹部手术史的患者施行是安全可行的。
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