腹腔镜下胆道镜液电碎石术治疗肝内外胆管结石

摘要

Objective:To summarize the methods,efficacy and safety of the cholangioscopy electrohydraulic lithotripsy with laparoscopy to treat intrahepatic bile duct calculi. Methods: The clinical data of 23 cases from Jan. 2005 to Jan. 2012 with refractory extra-hepatic and intrahepatic bile duct stones underwent cholangioscopy electrohydraulic lithotripsy with laparoscopy were retrospectively analyzed. The calculi-free rate and the incidence of complications were observed. Results:The rate of lithotripsy was 100 % in 23 cases, of which 22 were one-time free of biliary calculi, the free rate was 95. 7% ;0ne cases with more calculi underwent choledochoscope lithotomy through the T tube six weeks after surgery. No complications including biliary tract perforation, bleeding, bile leakage, wound infection and others were accurred. The peritoneal drainage tube was removed 3-4 d after operation,The hospital stay time was 5-7 d. 4 weeks after surgery, routine T-tube cholangiography was done, the T-tube was pinched for 3 d and then was removed. Conclusions: Lap-aroscopic cholangioscopy combined with electrohydraulic lithotripsy could significantly improve the therapeutic effect of the extrahepatic and intrahepatic bile duct calculi,which is safe and reliable.%目的:总结腹腔镜下胆道镜液电碎石术治疗肝内外胆管结石的手术方法、效果及安全性.方法:回顾分析2005年1月至2012年1月采用腹腔镜下胆道镜液电碎石术治疗23例难取性肝内外胆管结石患者的临床资料,观察结石取净率及并发症发生率.结果:23例术中均碎石成功,其中22例一次性取净结石,结石取净率95.7％；1例因结石数量较多,术后6周经T管窦道行胆道镜取石术.无胆道穿孔、大出血、胆漏、切口感染等并发症发生.术后3～4d拔除腹腔引流管,5～7d出院.术后4周常规行T管造影,夹管3d后拔除T管.结论:腹腔镜下结合胆道镜液电碎石术可显著提高肝内外胆管结石的疗效,手术安全、可靠.