腹腔镜肝左外叶切除免T管治疗肝内外胆管结石

T-Tube-free Laparoscopic Left Lateral Hepatectomy Management of Intra- or Extrahepatic Bile Duct Calculi

目的 探查腹腔镜切除肝左外叶联合术中胆道镜免T管治疗肝左外叶胆管结石合并（或不合并）胆囊结石、肝外胆管结石的可行性及安全性.方法 回顾性分析15例肝左外叶胆管结石患者的病例资料,其中合并肝外胆管5例,合并胆囊结石6例.采用腹腔镜切除肝左外叶及胆囊,选择左肝管残端为胆道镜进入通道,探查右肝管及肝外胆管,取出肝外胆管结石,缝合左肝断面胆管.结果 全部病例得以成功实施,平均手术时间133.6min（110.0 ～ 185.0） min,平均术中出血量169.7ml（85.0 ～ 355.0） ml,平均术后住院时间7.1 d（5.0～9.0）d,术后1例病人出现左肝断面感染,并轻度胆汁漏,带引流管出院,术后28天拔除引流管治愈,平均术后随访时间28.1 m（9.0～48.0）m,未见结石残留、复发.结论 选择合适的病例开展腹腔镜切除肝左外叶联合术中胆道镜免T管治疗肝左外叶胆管结石合并（或不合并）胆囊结石、肝外胆管结石是安全、可行的.

Objective To discuss the safty and feasibility for Laparoscopic Management of Intra-or Extrahepatic Bile Duct Calculi combine with intraoperative Cholangioscopy without T-Tube drainage.Methods There are 15 cases who suffering left-sided hepatolithiasis,5cases have common bile duct stones,and 6 cases have gallblader stones among them.After laparoscopically left hepatectomy,extrahepatic bile duct stones removal and right hepatic duct exploration were carried out under choledochoscope through the left hepatic duct.Results The operation was accomplished successfully in all cases.The mean operation time was 133.6 min（range,110.0-185.0min）,and mean blood loss was 169.7 ml,（range,85.0 ～ 355.0 ml）.1 patient suffer from left hepatic cross-section infection,28 days after operation the patient was cured,we pull out the drainage tube.The 15 patient were followed from 10-48 month,men 11.7month.No residual or recurrent stone were check out.Conclusions We think that intraoperative biliary exploration through left hepatic duct orifice in left-sided hepatolithiasis patients is an effective approach simplifying the operation procedure by avoiding choledochotomy and subsequent T-tube insertion.