腹腔镜下胆道镜和液电碎石机治疗继发性肝内外胆管嵌顿难取性结石  

Treatment of secondary intra-and extrahepatic cholangiolithiasis with electrohydraulic shock wave lithotripsy combined with laparoscope and choledochoscope

作　　者：张斌 曹宽 温泉 贾广宇 王人颢 ZHANG Bin;CAO Kuan;WEN Quan;JIA Guangyu;WANG Renhao(Department of Hepatobiliary Surgery,Affiliated Hospital of Xuzhou Medical University,Xuzhou Jiangsu 221004,China)

机构地区：[1]徐州医科大学附属医院肝胆外科,江苏徐州221004

出　　处：《局解手术学杂志》2018年第3期187-191,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：徐州市科技计划项目资助(KC15SM050)

摘　　要：目的探讨腹腔镜下胆道镜和液电碎石机治疗继发性肝内外胆管难取性结石的临床应用价值。方法回顾性分析徐州医科大学附属医院肝胆外科2012年5月至2015年12月行单纯腹腔镜下胆道镜治疗肝内外胆管结石42例患者(对照组)的临床资料,与2016年1月至2017年2月行腹腔镜下胆道镜联合液电碎石机治疗肝内外胆管结石42例患者(联合组)的临床资料进行对比分析。比较2组患者的中转开腹率(因炎症粘连中转开腹率和因嵌顿难取性结石中转开腹率)、胆总管结石残留率、胆漏发生率、胆总管狭窄发生率等。结果所有患者均康复出院。对照组42例患者中有6例中转开腹手术,其中2例因严重上腹部炎症粘连中转开腹手术,4例因嵌顿难取性结石中转开腹手术,无胆漏和胆管狭窄;术后有3例发生胆总管结石残留,无胆漏和胆管狭窄。联合组42例患者中有2例因严重上腹部炎症粘连中转开腹手术,无因嵌顿难取性结石中转开腹手术病例,5例患者术中行液电碎石操作,术后胆总管无残留结石,无胆漏和胆管狭窄。对照组术后胆总管残留结石经T管窦道胆道镜取石治愈。结论腹腔镜下胆道镜联合液电碎石机治疗肝内外胆管结石可以在微创手术治疗过程中降低因结石嵌顿所致中转开腹率和结石残留率,可以安全、有效地应用于有腹腔镜手术适应证的肝内外胆管结石患者。Objective To explore the clinical application value of electrohydraulic shock wave lithotripsy combined with laparoscope and choledochoscope in treatment of intra-and extrahepatic cholangiolithiasis.Methods The clinical data of 42 patients with intra-and extrahepatic cholangiolithiasis treated by laparoscope and choledochoscope(control group)in hepatobiliary surgery department of affiliated hospital of Xuzhou medical university from May 2012 to December 2015,and patients with intra-and extrahepatic cholangiolithiasis treated by electrohydraulic shock wave lithotripsy combined with laparoscope and choledochoscope(combined group)from January 2016 to February 2017,were retrospectively analyzed.The rate of transferring to laparotomy(transfer to laparotomy due to inflammatory adhesion or difficulty to remove),residual rate of choledocholithiasis,incidence of bile leakage and incidence of common bile duct stricture between two groups were compared.Results All patients in both groups were recovered.In the control group,there were 6 cases(6/42)transferred to laparotomy,among which 2 cases were transferred to laparotomy due to severe abdominal inflammatory adhesion and 4 cases were due to the difficulty to remove the calculus,without bile leakage or common bile duct stricture.There were 3 cases with residual choledocholithiasis,but without bile leakage or common bile duct stricture.In the combined group,there were 2 cases(2/42)transferred to laparotomy due to severe abdominal inflammatory adhesion and 5 cases used the technique of electrohydraulic shock wave lithotripsy without post-operation residual choledocholithiasis,bile leakage or bile duct stricture.In the control group,the residual choledocholithiasis was removed with T tube fistula choledochoscope.Conclusion In the process of minimally invasive surgery to treat intra-and extrahepatic cholangiolithiasis,electrohydraulic shock wave lithotripsy under laparoscope and choledochoscope can decrease the incidence of transferring to laparotomy due to the difficulty to rem

关 键 词：腹腔镜 液电碎石 胆管结石 微创手术 

分 类 号：R657.4[医药卫生—外科学]