应用腔镜技术治疗肝内外胆管结石的临床研究  

Use of endoscopy in the treatment of calculus of intrahepatic or extrahepatic duct:A clinical study

作　　者：陈亚进[1] 曹铭辉[2] 徐国权[1] 陈积圣[1] 

机构地区：[1]中山大学附属第二医院肝胆外科,广州510120 [2]中山大学附属第二医院麻醉科,广州510120

出　　处：《中国微创外科杂志》2004年第6期468-469,共2页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的　探讨腔镜技术在治疗肝内外胆管结石中的合理应用。　方法　应用腹腔镜结合十二指肠镜和纤维胆道镜治疗 96例肝内外胆管结石 ,其中胆囊结石合并胆总管结石 72例 ,单纯胆总管结石 16例 ,左肝管结石合并胆总管结石 8例。主要术式包括腹腔镜胆囊切除联合EST( 37例 )、腹腔镜胆囊切除术结合胆道镜胆道探查术 ( 5 4例 )、腹腔镜下左肝叶切除联合胆道镜胆管探查术 ( 5例 )。　结果　 96例中 ,93例术后复查无残留结石。 4例出现少量胆漏 ,平均 10天内自愈 ,无其它严重并发症发生。 3例中转开腹手术 ,其中 2例由于存在高位胆管狭窄 ,1例由于肝门部严重粘连水肿。　结论　腔镜治疗肝内外胆管结石可行 ,合理应用多种腔镜技术治疗肝胆管结石 ,可以达到安全。Objective To discuss the application of endoscopic techniques in the treatment of calculus of intrahepatic or extrahepatic duct. Methods Laparoscopy in conjunction with duodenoscopy or cholangioscopy was adopted in 96 cases of calculus of intrahepatic or extrahepatic duct, including 72 cases of cholecystolithiasis complicated by choledocholithiasis, 16 cases of simple choledocholithiasis and 8 cases of left intrahepatic duct calculus complicated by choledocholithiasis. The surgical procedures included laparoscopic cholecystectomy (LC) combined with EST (37 cases), LC combined with cholangioscopic exploration (54 cases), and laparoscopic left hepatic lobectomy combined with cholangioscopic exploration (5 cases). Results Postoperative re-examination revealed no residual calculus in 93 out of 96 patients. Small amounts of biliary leakage occurred in 4 patients and healed spontaneously within a mean time of 10 days. No other severe complications took place. A conversion to open surgery was required in 3 patients, 2 of which were high bile duct stricture and 1 of which were severe portal adhesion. Conclusions Endoscopy in the treatment of calculus of intrahepatic or extrahepatic duct is feasible. Proper application of multiple endoscopic techniques is a safe, effective and minimally invasive means for the treatment of cholelithiasis.

关 键 词：胆石症 内镜 肝切除 

分 类 号：R657.4[医药卫生—外科学]