中华肝胆外科杂志
中華肝膽外科雜誌
중화간담외과잡지
CHINESE JOURNAL OF HEPATOBILIARY SURGERY
2012年
8期
605-607
,共3页
刘天锡%方登华%杨浩雷%关斌颖%李滢旭%王星入
劉天錫%方登華%楊浩雷%關斌穎%李瀅旭%王星入
류천석%방등화%양호뢰%관빈영%리형욱%왕성입
胆道镜%肝胆管结石%腹腔镜%肝切除
膽道鏡%肝膽管結石%腹腔鏡%肝切除
담도경%간담관결석%복강경%간절제
Choledochoscopy%Hepatic calculus%Laparoscopic%Liver resection
目的 探讨胆道镜联合腹腔镜左肝叶切除治疗肝胆管结石的可行性及临床疗效.方法 选择肝胆管结石患者49例,全麻下行腹腔镜左肝外叶切除、左肝内叶切除、左半肝切除,联合胆道镜胆管探查取石.结果 29例患者在完全腹腔镜下行解剖性左肝外叶切除(ⅡⅢ段),2例行左肝内叶切除(Ⅳ段),18例行左半肝切除(ⅡⅢⅣ段).所有患者均联合胆道镜胆管探查和取石,11例联合腹腔镜胆囊切除(LC).平均手术时间为226 min,联合LC者平均手术时间为243 min.术中平均出血378 ml.术后未发生胆漏和出血等并发症.术后1～3 d肛门排气,胃肠功能恢复、进食,7～12d 痊愈出院.患者术后复查MRI、MRCP未发现结石残留.随访47例,平均16个月,患者恢复良好,未发现结石再发.结论 胆道镜联合腹腔镜左肝切除治疗肝胆管结石具有创伤小、恢复快、治疗彻底、临床疗效好等优点,是一种安全、有效、微创、可行的新手术方式.
目的 探討膽道鏡聯閤腹腔鏡左肝葉切除治療肝膽管結石的可行性及臨床療效.方法 選擇肝膽管結石患者49例,全痳下行腹腔鏡左肝外葉切除、左肝內葉切除、左半肝切除,聯閤膽道鏡膽管探查取石.結果 29例患者在完全腹腔鏡下行解剖性左肝外葉切除(ⅡⅢ段),2例行左肝內葉切除(Ⅳ段),18例行左半肝切除(ⅡⅢⅣ段).所有患者均聯閤膽道鏡膽管探查和取石,11例聯閤腹腔鏡膽囊切除(LC).平均手術時間為226 min,聯閤LC者平均手術時間為243 min.術中平均齣血378 ml.術後未髮生膽漏和齣血等併髮癥.術後1～3 d肛門排氣,胃腸功能恢複、進食,7～12d 痊愈齣院.患者術後複查MRI、MRCP未髮現結石殘留.隨訪47例,平均16箇月,患者恢複良好,未髮現結石再髮.結論 膽道鏡聯閤腹腔鏡左肝切除治療肝膽管結石具有創傷小、恢複快、治療徹底、臨床療效好等優點,是一種安全、有效、微創、可行的新手術方式.
목적 탐토담도경연합복강경좌간협절제치료간담관결석적가행성급림상료효.방법 선택간담관결석환자49례,전마하행복강경좌간외협절제、좌간내협절제、좌반간절제,연합담도경담관탐사취석.결과 29례환자재완전복강경하행해부성좌간외협절제(ⅡⅢ단),2례행좌간내협절제(Ⅳ단),18례행좌반간절제(ⅡⅢⅣ단).소유환자균연합담도경담관탐사화취석,11례연합복강경담낭절제(LC).평균수술시간위226 min,연합LC자평균수술시간위243 min.술중평균출혈378 ml.술후미발생담루화출혈등병발증.술후1～3 d항문배기,위장공능회복、진식,7～12d 전유출원.환자술후복사MRI、MRCP미발현결석잔류.수방47례,평균16개월,환자회복량호,미발현결석재발.결론 담도경연합복강경좌간절제치료간담관결석구유창상소、회복쾌、치료철저、림상료효호등우점,시일충안전、유효、미창、가행적신수술방식.
Objective To study the feasibility and efficacy of intraoperative choledoscopy combined with laparoscopic left liver resection to treat intrahepatic lithiasis.Method In 49 patients with biliary stone,laparoscopic left lateral sectionectomy/left medial sectionectomy/left hepatectomy combined with intraoperative choledochoscopy and stone retrieval were carried out.Results Laparoscopic left lateral sectionectomy was carried out in 29 patients,left medial sectionectomy in 2 patients and left hepatectomy in 18 patients.In all the patients,combined choledoscopy and stone retrieval were carried out.A concomitant laparoscopic cholecystectomy (LC) was carried out in 11 patients.The average operative time was 226 min.When LC was carried out,the mean operative time was 243 min.The mean intraoperative blood loss was 378 ml.There was no bile leak or postoperative bleeding.Flatus was passed 1-3 days after surgery.The patients were discharged home 7-10 days after surgery.Postoperative MRI/MRCP did not reveal any residual stone.On a mean follow up of 16 months for 47 patients,the patients did well and there was no recurrent stone.Conclusion Choledochoscopy combined with laparoscopic left liver resection for bile duct stone resulted in minimal trauma to the patient.The recovery was quick and there was a high stone clearance rate.The treatment was safe,efficacious,and it is a viable minimally invasive treatment option.
