腹腔镜配合胆道镜治疗肝内胆管结石  

Laparoscopic treatment combined with choledochoscopy for intrahepatic stones

作　　者：张涛[1] 凌亚菲 郭建平[1] 

机构地区：[1]广东省粤北人民医院普通外科,广东韶关512026

出　　处：《中国内镜杂志》2008年第3期290-291,294,共3页China Journal of Endoscopy

摘　　要：目的探讨腹腔镜治疗肝内胆管结石的方法。方法在腹腔镜下将肝内胆管结石患者肝总管高位切开至左右肝管汇合部,显露左右肝管的开口,在腹腔镜监视下取石。结果中转开腹1例(1.6%);55例(87.3%)术后仍有残石,需要1～4次胆道镜取石。结石完全清除56例(88.9%)。术后胆漏8例(12.7%),经腹腔引流治愈。51例(80.0%)随访1.5～5.0年,优43例(84.3%),良7例(13.7%),差1例(2.0%)。结论腹腔镜下肝内胆管结石可通过肝总管高位切开的方法较好地显露一、二级胆管,甚至三级胆管,在腹腔镜监视下将结石取出,配合胆道镜可使残余结石率大大降低。[Objective] To discuss surgical techniques of laparoscopic treatment combined with choledochoscopy for intrahepatic stones. [Methods] A total of 63 cases of intrahepatic stones from were studied. Under laparoscopic visualization, openings of left and fight hepatic bile ducts were exposed through a longitudinal incision in the common hepatic duct to the bifurcation of left and right hepatic ducts. Stones in left and right hepatic bile ducts were evacuated withthe use of a lithotomy forceps. [Results] Conversions to open surgery were required in 1 case （1.6%）. Residual stoneswere found in 55 cases （87.3%）, which required postoperative choledochoscopy for 1-4 times to clear the intrahepatic stones. Complete clearance of all intrahepatic stones was achieved in 56 cases （88.9%）. Postoperative bile leakage occurred in 8 cases （12.7%）, and was cured with tube drainage. Follow - up observations for 1.5- 5.0 years in 51 cases showed excellent outcomes in 43 cases （84.3%）, good outcomes in 7 cases （13.7%）, and poor in （2.0%）. [Conclusions] Intrahepatic stones can be removed laparoscopically through a longitudinal incision in the common hepatic duct to the bifurcation of left and right hepatic ducts for the exposure of primary and secondary hepatic ducts, or even tertiary hepatic ducts. Clearance rate of intrahepatic stones increased consumedly through laparoscopic treatment combined with choledochoscopy.

关 键 词：腹腔镜 胆道镜 肝内胆管结石 

分 类 号：R657.42[医药卫生—外科学]