Laparoscopic surgery for choledocholithiasis concomitant with calculus of the left intrahepatic duct or abdominal adhesions
Laparoscopic surgery for choledocholithiasis concomitant with calculus of the left intrahepatic duct or abdominal adhesions
复制标题
腹腔镜手术治疗胆总管结石合并左肝内管结石或腹部粘连
DOI：
10.1007/s00464-017-5555-4
复制
发表时间：
2017-11-01
影响因子：
3.1
通讯作者：
Liu, Houbao
中科院分区：
文献类型：
--
作者：
Wang, Yueqi;Bo, Xiaobo;Liu, Houbao
背景腹腔镜胆总管探查术（LCBDE）作为一种安全有效的治疗胆总管结石的方法近年来得到了广泛的推广。然而，对于合并左肝胆管结石和腹腔粘连的患者的治疗没有标准指南。本研究的目的是比较开放与腹腔镜胆总管探查左肝切除术的结果（OCBDH vs. LCBDH）在胆总管结石合并左侧肝胆管结石患者中的应用，并评估腹腔镜手术治疗胆总管结石合并腹腔粘连患者的安全性和可行性。共有321例胆总管结石患者接受了手术治疗。107例行LCBDE，111例行开放性胆总管探查术（OCBDE）。此外，分别有31名患者和72名患者接受了LCBDH和OCBDH。共133例接受LCBDE或OCBDE的患者发生了腹腔粘连，根据腹腔粘连评分系统将其分为轻度、中度或重度，该评分系统在LCBDE组和OCBDE组中得到了验证。结果在轻度粘连组中，LCBDE组术中出血量、术后恢复时间均少于OCBDE组。在中度粘连组中，LCBDE组的术后恢复时间明显短于OCBDE组。在重度粘连组中，LCBDE组的手术时间和出血量均高于OCBDE组。结论LCBDH能明显提高术后恢复，缩短住院时间。LCBDE对胆总管结石合并轻、中度腹腔粘连的患者是安全可行的。
BackgroundLaparoscopic common bile duct exploration (LCBDE) has been widely promoted in recent years as a safe and effective treatment for choledocholithiasis. However, there are no standard guidelines for the treatment of patients who have concomitant hepatolithiasis of the left liver and abdominal adhesions. The aim of the current research was to compare the outcomes of open versus laparoscopic common bile duct exploration with left hepatectomy (OCBDH vs. LCBDH) in patients with choledocholithiasis concomitant with left-sided hepatolithiasis, and to evaluate the safety and feasibility of laparoscopic surgery for choledocholithiasis in patients with abdominal adhesions.MethodsBetween October 2012 and October 2015, a total of 321 consecutive patients with choledocholithiasis underwent surgical treatment. LCBDE was performed in 107 patients, and open common bile duct exploration (OCBDE) was performed in 111 patients. Further, 31 patients and 72 patients underwent LCBDH and OCBDH, respectively. A total of 133 patients who underwent LCBDE or OCBDE had abdominal adhesions, which were classified as mild, moderate, or severe according to an abdominal adhesion scoring system, which was validated in the LCBDE group and OCBDE group. The perioperative results were reviewed and analyzed retrospectively.ResultsIn the mild adhesion group, blood loss, postoperative recovery in the LCBDE group was lesser than those in the OCBDE group. In the moderate adhesion group, the postoperative recovery was significantly shorter in the LCBDE group than in the OCBDE group. In the severe adhesion group, the operation time and blood loss in the LCBDE group were higher than those in the OCBDE group. The postoperative recovery was significantly better in the LCBDH group than in the OCBDH group.ConclusionLCBDH can obviously improve recovery and shorten the hospitalization period. Further, LCBDE is safe and feasible for patients of choledocholithiasis with mild and moderate abdominal adhesions.