腹腔镜技术联合胆道镜治疗复杂肝胆管结石的临床观察  

Clinical observation of laparoscopic technique combined with choledochoscopy in the treatment of complex hepatolithiasis

作　　者：陈宇泰 曾昕 谭澳宇 成伟[1] 刘毅[1] CHEN Yu-tai;ZENG Xin;TAN Ao-yu(The People's Hospital of Hunan Changsha 410005,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

出　　处：《肝胆外科杂志》2024年第4期259-263,共5页Journal of Hepatobiliary Surgery

摘　　要：目的 探讨腹腔镜技术联合胆道镜在治疗复杂肝胆管结石的临床疗效。方法 回顾性分析2020年1月至2022年06月收住于湖南省人民医院采用腹腔镜手术联合术中胆道镜治疗复杂肝胆管结石167例患者的临床资料。其中男性70例,女性97例;年龄49.6±13.5(17~76)岁。所有患者均有上腹部疼痛或寒战高热表现。既往上腹部手术史方面,合并肝部分切除术10例,合并胆肠内引流术16例。根据肝胆管结石分型,Ⅰ型(区域型)23例,Ⅱ型(弥漫型)42例,Ⅲ型(附加型,合并肝外胆管结石)102例。结果 本文167例患者手术时间232.87±49.73min,术中失血量113.89±79.41ml。术后肛门排气时间2.04±0.71d,术后住院时间8.46±2.65d。术后出现并发症27例:术后出血2例,均行介入栓塞止血;术后切口感染2例,加强换药后好转;术后胆瘘7例,其中1例经B超引导穿刺引流,余6例保持引流管通畅引流后好转;术后结石残留16例,3例术后口服溶石利胆药物后消失,余均术后3月经T管窦道胆道镜取石。所有病例均有完整随访,出院后胆管炎发作7例,其中2例经T管窦道胆道镜取石后未再发作,余经保守治疗后好转。随访过程中9例患者结石复发,6例经PTCSL和ERCP取净结石,2例行开腹胆道探查术取石,1例行开腹左半肝切除术取石。结论 在复杂肝胆管结石治疗中,充分术前评估,准确把握手术指征,熟练掌握腹腔镜技术与胆道镜操作技巧,联合应用腹腔镜和胆道镜治疗复杂肝胆管结石是一种安全、有效的方法。Objective To explore the clinical efficacy of laparoscopic technique combined with choledochoscopy in the treatment of complex hepatolithiasis.Methods The clinical data of 167 patients admitted to Hunan People's Hospital from January 2020 to June 2022 for the treatment of complex hepatolithiasis by laparoscopic surgery combined with intraoperative choledochoscopy were retrospectively analyzed.There were 70 males and 97 females;Age:49.6±13.5(17-76)years old.All patients had epigastric pain or chills and high fever.In terms of previous upper abdominal operation history,10 cases were combined with partial hepatectomy and 16 cases were combined with bilioenterostomy.According to the classification of hepatolithiasis,there were 23 cases of type I(regional type),42 cases of type II(diffuse type),and 102 cases of type II(additional type,combined with extrahepatic bile duct stones).Results The operation time of 167 patients was 232.87±49.73min,and the intraoperative blood loss was 113.89±79.41ml.Postoperative anal exhaust time was 2.04±0.71d,and postoperative hospitalization time was 8.46±2.65d.Postoperative complications occurred in 27 cases:postoperative hemorrhage occurred in 2 cases,all of which were stopped by interventional embolization.Postoperative incision infection occurred in 2 cases,which improved after intensive dressing change.There were 7 cases of biliary fistula after operation,1 case was improved by ultrasound-guided puncture drainage,and the other 6 cases were improved after maintaining the drainage tube.Postoperative stones remained in 16 cases,3 cases disappeared after oral administration of litholysis and choledochoscopy,and all the rest were removed by T-tube sinus choledochoscopy 3 months after operation.All cases were followed up completely,7 cases of cholangitis occurred after discharge,of which 1 case did not occur again after T-tube sinus choledochoscopy,and the remaining cases were improved after conservative treatment.During follow-up,9 patients had stone recurrence,6 patients had stone

关 键 词：复杂肝胆管结石 腹腔镜 胆道镜 

分 类 号：R657.4[医药卫生—外科学]