选择性左手控制技术在减少胆总管探查术中医源性损伤的作用

摘要

Objective To evaluate the clinical value of the left hand control technique applied to the choledochotomy to reduce the probability of iatrogenic biliary tract injury. Methods Between June 2006 and Mar 2012, 77 patients underwent open exploratory choledochotomy using left hand control technique, and another 77 corresponding period patients underwent the same operations without using this technique were randomized selected as the control group, the clinical records of the two groups were retrospectively compared and analyzed statistically. Results Comparisons of operation time[(96.376±24.099) min vs. (96.883±20.809)min] and postoperative hospital stay[(13.909±10.236)d vs. (13.181±8.465)d] between left hand control group and control group showed no significant difference(P>0.05), while postoperative complications comparison(16.883% vs. 38.961%)showed statistic difference(P<0.05). Five patients got intraoperative biliary tract hemorrhage,and six cases got lower segment wall contusion of common bile duct in the control group, while only two cases occurred respectively in the left hand control group. No cases complicated with perforation of the common bile duct back wall and duodenal perforation introoperatively in the left hand control group,while three patients in the control group. One duodenal papillary tumor and one inflammatory nodules were detected respectively in the left hand control group. Conclusion The left hand control technique being selectively applied to the exploratory choledochotomy can increase the operation security, reduce iatrogenic damage of the bile duct and peripheral ampullar region tissue,and contribute to the early detection of occult lesions of the distal common bile duct.%目的：评价选择性左手控制技术在胆总管探查术中降低医源性胆管损伤的临床应用价值。方法回顾性分析我院2006年6月至2012年3月77例选择采用左手控制技术施行胆总管探查术病例临床资料，统计其手术方式、及术中术后相关并发症，与同期77例非左手控制组胆总管探查术病例资料对比。结果左手控制组较对照组在手术时间[（96.376±24.099）min vs.（96.883±20.809）min）]及术后住院时间[（13.909±10.236）d vs.（13.181±8.465）d）]比较无统计学差异（P＞0.05），术后并发症发生率（16.883%vs.38.961%）有明显统计学差异（P＜0.05）。左手控制组术中出血量稍多；对照组术中胆道出血5例、胆管下段管壁挫伤6例，左手控制组各为2例；对照组胆管下端后壁穿孔1例及十二指肠侧壁穿孔2例，左手控制组无胆管或十二指肠穿孔病例；左手控制组术中发现十二指肠乳头肿瘤及炎性结节各1例，对照组未发现异常病变。结论选择性采用左手控制技术应用于胆总管探查术，增加了手术安全性，减少了医源性胆总管下端及壶腹部周围组织损伤的概率，有助于胆总管下端隐匿性病变的早期发现。