腹腔镜肝左外叶切除联合胆道镜治疗肝左外叶为主的结石23例

摘要

目的 探讨腹腔镜肝左外叶切除联合术中应用胆道镜在治疗肝左外叶肝内胆管结石中的可行性及安全性.方法 2014年11月至2016年10月对23例肝左外叶为主的肝内胆管结石病人行腹腔镜肝左外叶切除联合胆道镜检查及取石,其中9例病人合并胆总管结石,合并胆囊结石11例,同时合并胆总管结石及胆囊结石7例,合并肝左内叶结石3例.结果 23例病人均成功行腹腔镜下肝左外叶切除,并通过肝断面胆管经胆道镜对肝内胆管及胆总管检查、取石,9例病人通过胆道镜取出胆总管内结石,11例病人联合胆囊切除,3例病人通过胆道镜取出肝左内叶结石.所有病人手术顺利,手术时间为142～188 min,平均(157±27) min;术中出血量为150～550ml,平均(240±52) ml;胃肠功能恢复时间为1～3 d,平均(1.7±0.6)d;术后住院时间为7～13 d,平均(9.0±2.2)d.术后1例病人发生肝断面渗血,2例病人发生胆漏,均经保守治疗治愈.术后随访病人3～24个月,均未见结石残留及复发.结论 腹腔镜肝左外叶切除联合术中应用胆道镜治疗肝左外叶肝内胆管结石具有疼痛轻、恢复快、残石率低的优势,是一种安全、可行的手术方式,可在临床中广泛应用.%Objective To investigate the feasibility and safety of laparoscopic hepatectomy combined with choledochoscopy in the treatment of extrahepatic bile duct stones.Methods From November 2014 to October 2016,23 patients with extrahepatic bile duct stones were treated with laparoscopic left hepatic lobectomy combined with choledochoscopy and stone removal in Department of Hepatobiliary Surgery,Weifang People's Hospital.Of the 23 patients,9 patients were complicated with choledocholith and 11 patients with cholecvstolithiasis,7 cases with common bile duct stones and gallstones,and 3 cases with liver left lobe stone.Results Twenty-three patients were successfully given laparoscopic left lateral lobectomy of liver.Meanwhile,the intrahepatic bile duct and choledoch were explored by choledochoscope through hepatic cross section.The common bile duct stones were removed in 9 patients by choledochoscope,cholecystectomy was performed on 11 patients,and the left hepatic lobe stones were removed in 3 patients by choledochoscope.All operations were successfully completed.The operation duration was 142-188 min (mean 157 ± 27 min).The intraoperative blood loss was 150-550 mL (mean 240 ± 52 mL).The recovery time of gastrointestinal function was 1-3 days (mean 1.7 ± 0.6 days).The postoperative hospital stay was 7-13 days (mean 9.0 ± 2.2 days).Bleeding from the cut liver surface occurred in 1 case and bile leakage occurred in 2 cased after operation,which were all re solved by conservative treatment.Over a follow-up period of 3 months to 24 months,no residual stones or new stone formation were found.Conclusions Laparoscopic left hepatic lobectomy combined with choledochoscopy has the advantages of mild pain,quick recovery and low residual stone rate.It is a safe and feasible method for the treatment of extrahepatic bile duct stones,and can be widely used clinically.