腹腔镜肝切除联合胆道镜及腹腔镜超声治疗肝内外胆管结石的价值

Value of laparoscopic hepatectomy combined with choledochoscope and laparoscopic ultrasonography in the treatment of intrahepatic and extrahepatic cholelithiasis

目的探讨腹腔镜肝切除联合胆道镜及术中腹腔镜超声治疗肝内外胆管结石的临床价值。方法回顾性分析2016年1月至2018年12月在我院行腹腔镜左肝(外叶)切除联合胆道镜及术中腹腔镜超声治疗的38例左肝内外胆管结石患者的临床资料,术中应用超声对结石的部位、大小、范围及胆管血管情况作预先评估,确定切肝平面,再联合胆道镜探查进行网篮取石。结果本研究38例患者均成功完成手术,手术时间(249.05±82.20) min,术中出血(351.35±86.12) m L,术后肛门排气时间(28.06±6.41) h,住院时间(12.05±3.25) d。术后出现胆漏导致的断面积液2例,胸腔积液3例,胆道出血1例。随访12~48个月,患者均无结石残留及肝功能衰竭,未见结石复发。结论腹腔镜肝切除术中联合胆道镜及术中腹腔镜超声辅助能够有效降低术后结石残石率及复发率,可提高手术的安全性和精准性。

Objective To explore the clinical value of laparoscopic hepatectomy combined with choledochoscope and laparoscopic ultrasonography in the treatment of intrahepatic and extrahepatic cholelithiasis. Methods Retrospective analysis was performed on the clinical data of 38 patients with left intrahepatic and extrahepatic bile duct stones who underwent laparoscopic resection of the left liver( outer lobe)combined with choledochoscope and intraoperative laparoscopic ultrasonic treatment in our hospital from January 2016 to December 2018.Intraoperative ultrasound was used to pre-evaluate the location,size,scope of the stones,and the condition of the bile duct and blood vessels,so as to determine the level of liver resection and obtain the stones by net basket combine with choledochoscope. Results All the 38 patients successfully completed the operation. The operation time was( 249. 05 ± 82. 20) minutes,the intraoperative bleeding was( 351. 35 ± 86. 12) m L,the postoperative anal exhaust time was( 28. 06 ± 6. 41) hours,and the hospitalization time was( 12. 05 ± 3. 25) days. Postoperative complications including 2 cases of fluid accumulation in section due to biliary leakage,3 cases of pleural effusion,and 1 case of biliary tract hemorrhage. The patients were followed up for 12 to 48 months,and there was no residual stone or liver failure,and no recurrence of stone wasfound. Conclusion Laparoscopic hepatectomy combined with choledochoscope and laparoscopic ultrasonography can effectively reduce the postoperative stone residual rate and recurrence rate,and it can improve the safety and accuracy of surgery.