腹腔镜肝切除联合胆道镜治疗肝内外胆管结石36例  

Laparoscopic Hepatectomy Combined with Choledochoscopy for Hepatolithiasis Without T-tube Drainage: a Report of 36 Cases

作　　者：陈永标[1] 池小斌 江艺[1] 吕立志[1] 林建宇[1] 陈剑伟[1] 

机构地区：[1]福州总医院肝胆外科福建医科大学福总临床医学院,福州350025

出　　处：《中国微创外科杂志》2016年第9期777-779,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨腹腔镜肝切除联合胆道镜治疗肝内外胆管结石的可行性和安全性。方法 2012年7月～2015年6月采用腹腔镜肝切除联合胆道镜治疗36例左肝内胆管结石,其中合并胆总管结石11例,胆囊结石12例。采用腹腔镜肝左外叶或左半肝切除,均经左肝管残端插入电子胆道镜探查肝外胆管和右肝管,取出肝外胆管结石,缝合左肝断面胆管,不放置T管。结果 36例手术均获得成功,其中腹腔镜肝左外叶切除24例,左半肝切除12例,联合胆囊切除12例。手术时间130～180 min,平均148 min;术中出血量90～350 ml,平均190 ml。术后住院6～14 d,平均9 d。术后1例胆漏内镜逆行胰胆管造影检查后,胆总管内放置胆道支架减压引流,带引流管出院,术后28 d拔除引流管治愈。36例随访6～42个月,平均22个月,优30例,良6例,未见结石残留、复发。结论腹腔镜左肝切除、经左肝管残端胆道镜取石,不放置T管,有利于加速患者康复,缩短住院时间,是可供选择的手术方式。Objective To study the feasibility and safety of laparoscopic hepatectomy combined with choledochoscopy for hepatolithiasis without T-tube drainage. Methods The study included the 36 patients, 11 patients were complicated 36 patients with hepatolithiasis in the left intrahepatic duet. Of choledocholith and 12 patients with cholecvstolithiasis. After laparoscopic left hepatectomy, extrahepatic bile duct stone removal and right hepatic duct exploration were carried out under video-assisted eholedochoscopy through left hepatic duct without choledochotomy and T-tube drainage. Results The operation was successfully accomplished in all the 36 patients. Liver procedures included laparoscopic left lateral lobectomy in 24 patients and left hemihepatectomy in 12 patients. The mean operation time was 148 rain （range, 130 -180 rain） , and the mean blood loss was 190 ml （range, 90- 350 ml）. There was 1 case of bilialT leakage, which was cured by bilialT stent placement in common bile duct for decompression drainage after endoscopic retrograde cholangiopancreatography. The mean postoperative hospital stay was 9 d （range, 6 - 14 d）. The 36 patients were followed for a mean of 22 months （range, 6 -42 excellent in 30 patients and good in 6. No residual or recurent stones were noted. months）. The curative effects were classified as Conclusions Laparoscopic hepatectomy without T-tube drainage for the treatment of hepatolithiasis is feasible and safe in selected patients. This procedure offers advantages of rapid rehabilitation and short hospital stay, being a worthwhile minimally invasive alternative.

关 键 词：腹腔镜 肝切除术 肝管结石 

分 类 号：R657.42[医药卫生—外科学]