全腹腔镜胆囊肝管型皮下通道治疗肝内胆管结石11例

Total laparoscopy to treat hepatolithiasis using gallbladder-hepatic duct subcutaneous tunnel

肝内胆管结石病情复杂多变、治愈率低、易复发等,一直困扰临床治疗,随着目前诊断技术的发展及精准外科理念的提出,对肝内胆管结石的外科治疗提出了更高的要求,尤其是微创治疗更是目前的治疗热点,近年来,随着腹腔镜外科技术不断成熟,手术安全性不断提高,在腹腔镜下完成肝内胆管结石的治疗已成为可能。

To investigate the effect and feasibility of total laparoscopy to treat hepatolithiasis using gallbladder-hepatic duct subcutaneous tunnel. Retrospective analysis was conducted of the case data of 11 patients with hepatolithiasis who underwent total laparoscopic treatment using gallbladder-hepatic duct subcutaneous tunnel from January 2010 to October 2014. The operation time,blood loss,postoperative complications and recurrence of stones were recorded. All the cases completed the operation. The average hospital-stay was 9. 2 days（ range： 3- 29 d）. The average operation time was 298 min（ range： 225- 480min）. The average blood loss was 253 m L（ range： 50- 700 m L）,and the average blood loss of liver resection groups was 325 m L（ range： 200- 700 m L）. The average discharge time was 3. 3 days（ range：3- 5 d）. The rate of postoperative residual stones was 36. 4%（ 4 /11）. We extracted stones with choledochofiberscope via T-tube sinus six weeks after operation. One case developed biliary leakage,and healed through adequate drainage and the T-tube was pulled out after one month. There was no perioperative mortality. All the cases were followed up and the mean follow-up was 22 months（ range： 2- 51months）. The anastomotic stenosis of gallbladder-hepatic duct was found in one case. But we got a good therapeutic result with performed gallbladder chemical ablation with 95% ethanol. No recurrence of hepatolithiasis was found. As a choice for minimally invasive method to hepatolithiasis using gallbladder-hepatic duct subcutaneous tunnel,total laparoscopy is a safe and feasible procedure.