一种新型腹腔镜下免气腹硬质内镜钬激光碎石治疗肝内胆管结石的疗效  

Clinical efficacy of a novel type of laparoscopic pneumoperitoneum-free rigid endoscopic holmium laser lithotripsy for hepatolithiasis

作　　者：陈晨[1] 罗佳 汪新天[1] 彭创[1] 蒋超[1] 李浩[1] 王永刚[1] 何自力[1] 梁路峰[1] 王永[1] 张凝乐 李业荣 王涛[1] 张占国 Chen Chen;Jia Luo;Xintian Wang;Chuang Peng;Chao Jiang;Hao Li;Yonggang Wang;Zili He;Lufeng Liang;Yong Wang;Ningle Zhang;Yerong Li;Tao Wang;Zhanguo Zhang(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Hunan Normal University(People's Hospital of Hunan Province),Changsha 410005,China;Liver Surgery Center,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]湖南师范大学附属第一医院(湖南省人民医院)肝胆外科,长沙410005 [2]华中科技大学同济医学院附属同济医院肝脏外科中心,武汉430030

出　　处：《中华肝脏外科手术学电子杂志》2024年第2期200-204,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：湖南省临床医疗技术创新引导项目(2020SK50917);湖南省肝胆胰肠诊疗能力提升项目(湘卫(2019)118号);湖南省中医药科研课题(C2023025)。

摘　　要：目的:探讨新型腹腔镜下免气腹硬质内镜钬激光碎石治疗肝内胆管结石的疗效。方法:回顾性分析2023年3月至2023年5月在湖南省人民医院接受腹腔镜下免气腹硬质内镜钬激光碎石手术的6例肝内胆管结石患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男1例,女5例;年龄46~68岁,中位年龄62岁。采用自行研制的新型腹腔镜下硬质内镜钬激光碎石治疗肝内胆管结石,取石过程中无需气腹状态。观察围手术期情况及并发症等。结果:患者均手术顺利,无中转开腹。患者平均手术时间(145±22)min,术中出血量5~50 ml,中位出血量10 ml。术后住院时间(5.0±0.6)d。围手术期无发生死亡,术中及术后未发生高碳酸血症、气栓、皮下气肿、腹腔感染、胆道出血等并发症,均康复出院。术后第3天复查CT肝内胆管结石无残石。结论:本中心自行研制的新型腹腔镜下免气腹硬质内镜钬激光碎石治疗肝内胆管结石安全、有效,能有效减少术中气腹相关并发症发生,提高手术效率,缩短手术时间。Objective To evaluate clinical efficacy of a novel type of laparoscopic pneumoperitoneum-free rigid endoscopic holmium laser lithotripsy in the treatment of hepatolithiasis.Methods Clinical data of 6 patients with hepatolithiasis who underwent laparoscopic pneumoperitoneum-free rigid endoscopic holmium laser lithotripsy in People's Hospital of Hunan Province from March 2023 to May 2023 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,1 patient was male and 5 female,aged 46-68 years,with a median age of 62 years.A new type of laparoscopic rigid endoscopic holmium laser lithotripsy was self-designed,and pneumoperitoneum was not required intraoperatively.Perioperative conditions and complications were observed.Results All patients successfully completed the surgery,and no conversion to open surgery occurred.The average operation time was(145±22)min,and intraoperative blood loss was 5-50 ml,witha median blood loss of 10 ml.The length of postoperative hospital stay was(5.0±0.6)d.No death occurred during perioperative period.No complications,such as hypercapnia,air embolism,subcutaneous emphysema,abdominal infection and biliary bleeding,occurred during and after surgery.All patients were recovered and discharged.CT scan at postoperative 3 d showed no residual hepatolithiasis.Conclusions The self-designed novel type of laparoscopic pneumoperitoneum-free rigid endoscopic holmium laser lithotripsy is a safe and efficacious treatment for hepatolithiasis,which can effectively reduce the incidence of intraoperative pneumoperitoneum-related complications,improve surgical efficiency and shorten operation time.

关 键 词：肝内胆管结石 免气腹 腹腔镜 钬激光碎石术 

分 类 号：R657.4[医药卫生—外科学]