直视微创手术技术在复杂肝外胆道手术中的应用.pdfVIP

· J实用临床医药专志 2008年第12卷第1期 ournal of CIinieal Medicine in Practice … ’ … 。 58· 。 直视微创手术技术在复杂肝外胆道手术中的应用 张培建，刘新颜，田明祥，陶立德，冯 敏，周 斌，张 淼 (扬州大学第--@床医学院普通外科，江苏扬州，225001) 摘 要：目的 将直视微创手术技术应用于复杂肝外胆道手术，降低生理干扰、减少并发症。方法 采用直视微创胆道外 科手术器械，相对固定的手术步骤、技巧，施行胆囊三角区和胆囊床微创分离，胆囊管、胆囊动脉和胆总管的微创操作技术。结 果 本组137例复杂肝外胆道手术均在直视微创下完成。胆囊切除手术切口2．5--4．0 c打1(平均3．8 cln)，胆囊切除+胆总管 切开取石、“r’型管引流手术切口4．0～5．0 cm(平均4．5 cIn)；除1例因胆道损伤于术后第l1天行剖腹探查，胆总管空肠Roux — en-Y吻合术以外，其余无胆道损伤、术后出血及死亡病例；术后无痛或微痛。结论 直视微创肝外胆道手术技术创伤小、适应 证广。 关键词：微创；胆道外科；手术 中图分类号：R 657．4 文献标识码：A 文章编号：1672—2353(2008)01-0058-03 Microinvasive laparoscopy applied in extrahepatic biliary—tract surgery ZHANG Pei-jian，L1U Xin-yan，Tian Ming-xiang，TAO Li—de， FENG Min，ZHOU Bin，ZHANG Miao (Department ofGeneral Surgery，No．2 clinical Hospital，Yangzhou University，Yangzhou，Jiangsu，225001) ABSTRACT：Objective To evaluate the effect of microinvasive laparoscopy on complicated ex— trahepatic biliary-tract diseases．Methods Colottriangle and cholecystis-bed were dissected routine— ly under the guidance of endoscope and cholecystis—tube，cholecystis—artery and billiary—tract were microinvasively operated．Results Cholecystectomy was performed with laparo scope(2．5±4．0 cm)in 137 cases．The average length of the incision was 3．8 cm for 4．0～5．0 cm for cholecystec— tomy choledocholithotomy and T-tube drainage respectively．Except for one patient needed chole-in— testinal anastomosis due to bile duct injury on the llth day after the procedure，no bile duct injury， death and post—operative hemorrahge Was seen．No or slight pain Was complained by the patients． Conclusion Microinvasive laparoscopy is applied in extrahepatic biliary-tract surg