腹腔镜、胆道镜引导下钬激光碎石术治疗肝内外胆管结石的临床体会

Clinical experience of laparoscopic and choledochoscopic-guided holmium laser lithotripsy in the treatment of intra- and extrahepatic bile duct lithiasis

目的:探讨腹腔镜胆道镜引导下钬激光碎石治疗肝内外胆管结石的可行性。方法:回顾分析2008～2012年为45例肝内外胆管结石患者行腹腔镜胆道镜引导下钬激光碎石治疗的临床资料。结果:45例患者中3例中转开腹;42例成功完成手术,手术时间90～150 min,平均(110±16)min。术后残留结石7例,6例一次取石成功,1例两次取石成功;术后均有轻至中度肝功损害,对症治疗后痊愈;1例少量胆漏,经引流治愈,无切口感染、血栓等其他并发症发生。结论:腹腔镜、胆道镜引导下钬激光碎石术治疗肝内外胆管结石具有患者创伤小、术后康复快等优点,安全、实用。

Objective：To investigate the feasibility of laparoscopic and choledochoscopic-guided holmium laser lithotripsy in the treatment of intra- and extrahepatic bile duct lithiasis. Methods：The clinical data of 45 patients who suffered from intra- and extra- hepatic bile duct lithiasis and underwent laparoscopic and choledochoscopic-guided holmium laser lithotripsy were retrospectively ana- lyzed. Results：Of all these 45 cases,3 cases were converted to open operation,42 cases were successfully completed, operating time was 90-150 min,with the average of （ 110 ＋ 16） rain. After operation 7 cases had residual stone,and the stone in 6 cases was removed one time, two times in 1 case. All cases existed liver function damage, and all were cured after symptomatic therapy, 1 case occurred a small amount of biliary leakage,and was cured after drainage, no other complications were found, such as wound infection, thrombus and so on. Conclusions ： The treatment of intra- and extrahepatic bile duct lithiasis by laparoscopy with choledochoscope and holmium laser is minimally invasive,safe and effective,patients recover quickly.