目的 探讨腹腔镜下胆道镜联合钬激光治疗难取性肝胆管结石的临床应用价值.方法 回顾性分析18例难取性肝胆管结石病人在腹腔镜下通过胆道镜联合钬激光,将肝胆管结石击碎后注水冲出或用取石篮套出的临床资料.结果 本组18例均取石成功,取石时间10～18 min,平均15min.术后无胆道出血、胆漏.术后随访6个月,腹部B型超声或经T管胆道造影检查,取石成功者未发现结石复发及残留,无胆道狭窄.结论 腹腔镜下胆道镜联合钬激光治疗难取性肝胆管结石,具有创伤小、恢复快、安全有效等优点,为治疗肝胆管结石开辟了一条新的治疗途径.%Objective To investigate the applied value of laparoscopy with cholangioscopy and holmium laser for refractory hepatolithiasis. Methods The clinical data of 18 cases of refractory hepatolithiasis treated by laparoscopy with cholangioscopy and holmium laser were retrospectively analyzed. The stones were fragmented and extracted with irrigation or by using a basket. Results The stones were successfully removed in all 18 cases. Operating time was 10-18 min (mean 15 min). There was no biliary tract bleeding and no bile leakage. Patients were followed up for 6 months. Under the abdominal B- ultrasound or by using T tube cholangiography examination, there was no stone recurrence, residue and biliary stricture. Conclusion The treatment of refractory hepatolithiasis by laparoscopy with cholangioscopy and holmium laser is had the advantages of minimal invasion, quick recover y, safety and effectiveness.
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