腹腔镜胆道镜联合钬激光治疗肝内胆管结石115例体会

The treatment of intrahepatic lithiasis by laparoscopy with choledochoscope and holmium laser:115 cases report

目的探讨腹腔镜胆道镜联合钬激光治疗肝内胆管结石的疗效及应用价值。方法应用腹腔镜、胆道镜、钬激光治疗肝内胆管结石115例,经胆总管取石。术后2～3个月经T管窦道再次胆道镜探查及取石。结果顺利完成手术106例,成功率92.2%,9例中转开腹(7.8%)。30例术后Ⅲ级胆管残留结石(26.1%),8例Ⅱ级胆管残留结石(7.0%),胆总管无残留结石。经T管窦道胆道镜探查97例,取石27例(27.8%),其中单纯取石篮套取石19例(19.6%),再次钬激光碎取石8例(8.2%)。多次镜下取石6例,1例镜下取石多达12次。再次手术3例(2.6%)。结论腹腔镜胆道镜联合钬激光治疗肝内胆管结石微创、高效,且安全实用。

Objective To investigate the therapeutic effect and application value in the treatment of intrahepatic lithiasis by laparoscopy with choledochoseope and holmium laser. Methods One hundred and fifteen patients who suffered from intrahepatic lithiasis were treated by laparoscopy with cholangioscopy and hiomius laser via commota bile duct, and were again operated by choledochoscope through T tube sinus tract after two or three months. Results One hundred and six operations were successfully completed, surgical success rate was 92.2 %, 9 cases were converted to open （ 7.8 % ）, 30 cases were discovered postoperative residual stones in ]lI grade bile duct （ 26.1% ）, 8 cases existed residual stones in lI grade bile duct （ 7.0 % ）, but there was not residual stones in common bile duct. Ninety-seven cases were treated by choledochoscope through T tube sinus tract. Twenty-seven cases stone was removed （ 27.8 % ）, including 19 cases with using only basket （ 19.6 % ） and 8 cases with using again hohnium laser （ 8.2 % ）. Six cases were repeatedly operated, including 1 case up to 12 times. Three cases was suffered from open operation （ 2.6 % ）. Conclusions It is minimally invasive, safe and effective to treat intrahepatic lithiasis by laparoscopy with cholangioscopy and holmium laser.