完全腹腔镜肝切除术中顺行胆道镜检查临床应用.docVIP

完全腹腔镜肝切除术中顺行胆道镜检查临床应用 　 作者：刘荣 胡明根 赵向前 董家鸿 黄志强　 【摘要】 目的 介绍完全腹腔镜肝切除术中顺行胆道镜检查治疗肝胆管结石的技术要点，初步探讨其临床应用价值。方法 2002年6月至2005年12月，11例左肝内胆管结石患者在我科行腹腔镜肝切除术，术中经左肝管残端置入胆道镜探查胆总管及右肝管，根据结果行取石、胆道冲洗治疗，术后封闭左肝管残端。结果 11例均成功行完全腹腔镜肝切除术，其中左外叶切除术6例(联合胆囊切除3例)，左半肝切除术5例(联合胆囊切除1例)。术中应用胆道镜行单纯胆道冲洗5例，胆总管取石3例，右肝管取石2例，1例因探查发现右肝管开口狭窄而中转行胆管成形术。手术时间(201.4±57.5)min，出血量(136.4±68.6)ml，其中胆道镜探查时间(42.3±12.1)min。术后住院时间(4.6±1.6)d。术后随访(22.5±11.6)个月，优9例，良2例。结论 腹腔镜下顺行胆道镜可以不放置T管，从而缩短恢复时间，减轻患者痛苦，是一项安全、可行的技术。 【关键词】 腹腔镜肝切除； 肝内胆管结石； 胆道镜检查 【Abstract】 Objective To introduce the technique and discuss the values of grade choledochoscopy during total laparoscopic liver resections. Methods From June 2002 to December 2005, 11 cases of hepatolithiasis in the left intrahepatic duct underwent total laparoscopic liver resections in our department. After left hepatectomy, videoassisted choledochoscopy was placed through the left hepatic duct to explore the common bile duct and the right hepatic duct in order to remove the stones. The stump of the left hepatic duct was sealed post operation. Results The operation was successfully done in all 11 cases including 6 cases (combined with cholecystectomy in 3 cases) treated with left lateral lobetectomy and 5 (combined with cholecystectomy in 1 case) treated with left hemihepatectomy. The choledochoscopy was used to wash bile duct in 5 cases and remove stones in 5 including 3 with common bile duct stones and 2 with right hepatic duct stones. One case converted to bile duct plasty after a stricture was found at the origination of the right hepatic duct. The mean operation time was (201.4±57.5) minutes (105255 minutes) and the mean intraoperative blood loss (136.4±68.6) ml (50250 ml). Thereinto, the mean time of choledochoscopy was (42.3±12.1) minutes (2560 minutes). The postoperative hospital stay was (4.6±1.6) days (38 days). The followup for (22.5±11.6) months showed that the result was excellent in 9 cases and good in 2. Conclusions Grade choledochoscopy through left hepatic bil