腹腔镜联合胆道镜治疗肝内胆管结石合并胆总管结石疗效

Efficacy of laparoscopy combined with choledochoscopy in treatment of hepatolithiasis complicated with choledocholithiasis

目的探讨腹腔镜联合胆道镜治疗肝内胆管结石合并胆总管结石的安全性和有效性。方法回顾性分析2014年1月到2018年12月在复旦大学附属上海市浦东医院接受腹腔镜肝切除联合胆道镜取石的32例肝内胆管结石合并胆总管结石患者临床资料。其中男13例,女19例;年龄32~84岁,中位年龄59岁。患者均签署知情同意书,符合医学伦理学规定。观察患者手术情况及术后恢复情况。结果29例患者完成腹腔镜手术,3例中转开腹,其中行肝左外叶切除27例,左半肝切除5例。胆总管切开取石并放置T管18例,胆道镜取石14例。平均手术时间(221±41)min,术中出血量(260±62)ml。术后肛门恢复排气时间(42±17)h,术后住院时间(10±2)d。术后出血3例,经输血、应用止血药物治疗后止血;术后胆漏3例,经引流后10 d自愈;无腹腔感染等其他并发症。术后胆总管残余结石2例,均采用胆道镜经T管窦道取出结石。结论腹腔镜联合胆道镜治疗肝内胆管结石合并胆总管结石是安全、有效的。

Objective To evaluate the safety and efficacy of laparoscopy combined with choledochoscopy in the treatment of hepatolithiasis complicated with choledocholithiasis.Methods Clinical data of 32 patients with hepatolithiasis complicated with choledocholithiasis who underwent laparoscopic hepatectomy combined with choledochoscopy in Shanghai Pudong Hospital Affiliated to Fudan University from January 2014 to December 2018 were retrospectively analyzed.Among them,13 patients were male and 19 female,aged from 32 to 84 years with a median age of 59 years.The informed consents of all patients were obtained and the local ethical committee approval was received.The intraoperative conditions and postoperative recovery of the patients were observed.Results 29 patients completed laparoscopic surgery while 3 cases were converted to open surgery.Among them,27 cases underwent the left lateral hepatectomy and 5 left hemi-hepatectomy.18 patients underwent choledocholithotomy and the placement of T tube,and 14 cholangioscopic lithotomy.The average operation time was(221±41)min,and the intraoperative blood loss was(260±62)ml.The postoperative anal exhaust time was(42±17)h,and the length of postoperative hospital stay was(10±2)d.Postoperative hemorrhage occurred in 3 cases,which were treated with blood transfusion and administration of hemostatic drugs.Postoperative bile leakage was observed in 3 cases,which were healed after drainage for 10 d.No other complications,such as abdominal infection,were noted.Postoperative residual choledocholithiasis occurred in 2 cases,which were removed by cholangioscopic lithotomy through the T tube sinus tract.Conclusion Laparoscopy combined with choledochoscopy is safe and efficacious in the treatment of hepatolithiasis complicated with choledocholithiasis.