腹腔镜联合刮吸解剖法治疗复发性胆管结石

摘要

Objective To evaluate the feasibility and safety of laparoscopy combined with curettage and aspiration dissection technique for recurrent bile duct stones . Methods Twenty-five patients with recurrent bile duct stones were reoperated by laparoscopy combined with curettage and aspiration dissection technique from January 2011 to December 2014.The four-port technique was used for all the patients .Curettage and aspiration dissection techniques were used to separate peritoneal adhesion and expose extrahepatic bile duct . The stones were removed out under choledochoscope . Hepatectomy was performed in 6 patients. Results Of the 25 cases, laparoscopic bile duct re-exploration was completed in 22 cases (88.0%).Among them, T-tube drainage was used in 16 patients, and primary common duct closure in 6 patients.Left lateral lobe hepatectomy was simultaneously performed in 4 patients, and left hepatectomy in 1 patient.Conversions to open operation were required in 3 patients because of internal duodenal fistula, stones in distal bile duct, and errhysis from liver section, respectively.No severe complications occurred during and after procedure.The mean operative time was (172.3 ±40.3) min, the intraoperative hemorrhage volume was (96.0 ±22.5) ml, and the post-operative hospital stay was (6.9 ±3.6) d.Mild bile leakage was found in 3 patients (13.6%), and residual stones in 2 patients (9.1%).They were all cured by non-surgical approaches.No recurrence was observed during a mean follow-up of 24 months (range, 12-48 months). Conclusion Laparoscopic bile duct re-exploration combined with curettage and spiration dissection technique is safe and feasible provided it is performed by experienced laparoscopic surgeons .%目的：探讨腹腔镜联合刮吸解剖法治疗复发性胆管结石的可行性和安全性。方法2011年1月～2014年12月我科对25例复发性胆管结石行腹腔镜胆管切开取石术。采用四孔法，刮吸法分离肝下粘连，显露肝外胆管，胆道镜取石后放置T管或一期缝合，6例联合行刮吸法肝切除术。结果腹腔镜手术成功22例，成功率88．0％（22／25），其中T管引流16例，胆总管切开一期缝合6例；联合肝左外叶切除4例，左半肝切除1例。中转开腹3例：1例胆总管与十二指肠瘘，1例胆总管下端结石嵌顿，1例肝断面渗血，腹腔镜下难以处理。术中、术后均无严重并发症发生。手术时间（172．3±40．3）min；术中出血量（96．0±22．5）ml；术后住院时间（6．9±3．6）d。术后轻度胆漏3例（13．6％），胆管残余结石2例（残石率9．1％），均经非手术方法而愈。22例平均随访24个月（12～48个月），未见结石复发。结论腹腔镜联合刮吸解剖法治疗复发性胆管结石安全可行，但术者需选择合适的病例，并有熟练的腔镜、内镜技术和丰富的胆道手术经验。