全腹腔镜胆囊肝管型皮下通道治疗肝内胆管结石11例  

Total laparoscopy to treat hepatolithiasis using gallbladder-hepatic duct subcutaneous tunnel

作　　者：李涛[1] 崔龙[2] 王港[2] 凌晓锋[2] 侯纯升[2] 王立新[2] 徐智[2] 

机构地区：[1]陕西省榆林市第二医院普外二科 [2]北京大学第三医院普外科,北京100191

出　　处：《北京大学学报（医学版）》2016年第5期915-918,共4页Journal of Peking University:Health Sciences

摘　　要：肝内胆管结石病情复杂多变、治愈率低、易复发等,一直困扰临床治疗,随着目前诊断技术的发展及精准外科理念的提出,对肝内胆管结石的外科治疗提出了更高的要求,尤其是微创治疗更是目前的治疗热点,近年来,随着腹腔镜外科技术不断成熟,手术安全性不断提高,在腹腔镜下完成肝内胆管结石的治疗已成为可能。To investigate the effect and feasibility of total laparoscopy to treat hepatolithiasis using gallbladder-hepatic duct subcutaneous tunnel. Retrospective analysis was conducted of the case data of 11 patients with hepatolithiasis who underwent total laparoscopic treatment using gallbladder-hepatic duct subcutaneous tunnel from January 2010 to October 2014. The operation time,blood loss,postoperative complications and recurrence of stones were recorded. All the cases completed the operation. The average hospital-stay was 9. 2 days（ range： 3- 29 d）. The average operation time was 298 min（ range： 225- 480min）. The average blood loss was 253 m L（ range： 50- 700 m L）,and the average blood loss of liver resection groups was 325 m L（ range： 200- 700 m L）. The average discharge time was 3. 3 days（ range：3- 5 d）. The rate of postoperative residual stones was 36. 4%（ 4 /11）. We extracted stones with choledochofiberscope via T-tube sinus six weeks after operation. One case developed biliary leakage,and healed through adequate drainage and the T-tube was pulled out after one month. There was no perioperative mortality. All the cases were followed up and the mean follow-up was 22 months（ range： 2- 51months）. The anastomotic stenosis of gallbladder-hepatic duct was found in one case. But we got a good therapeutic result with performed gallbladder chemical ablation with 95% ethanol. No recurrence of hepatolithiasis was found. As a choice for minimally invasive method to hepatolithiasis using gallbladder-hepatic duct subcutaneous tunnel,total laparoscopy is a safe and feasible procedure.

关 键 词：胆管 肝内 结石 胆道外科手术 腹腔镜 

分 类 号：R575[医药卫生—消化系统]