悬吊式腹腔镜联合胆管镜治疗肝内外胆管结石32例疗效剖析.docVIP

悬吊式腹腔镜联合胆管镜治疗肝内外胆管结石32例疗效剖析 　　[摘要] 目的：探讨悬吊式腹腔镜联合胆管镜治疗肝内外胆管结石的疗效及应用价值。方法：回顾分析本院2009年8月～2011年3月经悬吊式腹腔镜联合胆管镜治疗的32例肝内外胆管结石患者的临床资料。结果：结果显示，32例患者采用LC 及腹腔镜胆总管切开联合纤维胆管镜胆管探查取石术后，手术均获得成功，无严重并发症发生。其中，手术时间为79～220 min， 平均125 min；术中出血量为35～210 ml，平均55 ml。所有患者均被取出胆管结石。结论：悬吊式腹腔镜胆管镜联合治疗肝内外胆管结石具有创伤小、恢复快、结石清除率高等优点，比气腹腹腔镜操作简单，值得推广。 　　[关键词] 腹腔镜；胆管镜；胆总管结石；疗效分析 　　[中图分类号] R575.7 [文献标识码]A[文章编号]1674-4721（2011）07（a）-033-02 　　 　　Suspended mirror laparoscopic treatment of intrahepatic and extrahepatic bile duct stones in 32 cases 　　LAI Guangmang, LI Yuxin, HUANG Hongwei 　　The People′s Hospital of Puning City, Guangdong Province, Puning 515300, China 　　[Abstract] Objective: To investigate the feasibility and clinical value of combined with choledo choscope in the treatment of intrahepatic and extrahepatic bile duct cholelithiasis. Methods: The clinical data of 32 patients received common bile duct incision exploration to remove stones under combined with fiber- choledochoscopy from August 2009 to March 2011 were retrospectively. Results: All cases were operated on successfully without conversion to open operation. There was no serious complication. The operation time was 79-220 min (average was 125 min), the bleeding in the operation was 35-210 ml (average was 55 ml). The stones were extracted. Conclusion: Combined with the management of intrathepatic and extrahepatic bile duct stones is safety, reliable and minimally invasive procedure. 　　[Key words] Laparoscopy; Bile duct mirror; Common bile duct stone; Efficacy 　　 　　腹腔镜手术在肝胆外科领域中的应用越来越广泛。目前国内外开展的腔镜手术主要有充入二氧化碳的气腹法腹腔镜（即常规腹腔镜）和腹壁悬吊的无气腹法腹腔镜（即悬吊式腹腔镜）[1]。悬吊式腹腔镜是腹腔镜外科的重要进展，与气腹法比较具有更高的安全性和可操作性，并且经济实用。悬吊式腹腔镜和胆管镜（即双镜）联合手术治疗肝内外胆管结石手术在国内报道较少，属于一种微创外科新技术。本院近2年来应用悬吊式双镜联合治疗肝内外胆管结石患者32例，取得较好疗效，现报道如下： 　　1 资料与方法 　　1.1 一般资料 　　收集2009年8月～2011年3月肝内外胆管结石患者共32 例，其中，男20 例，女12例。年龄36～75岁，平均58岁。患者均有不同程度的上腹部疼痛、发热，特别是黄疸等症状。术前经B超、CT等确诊（结石大小为5～20 mm），现分类如下：胆总管结石患者21 例，左、右肝内胆管合并胆总管结石患者7例，左肝内胆管结石患者4例；所有患者均伴有胆囊结石。下列患者可入选进行手术：B超或CT等提示胆总管扩张、合并有肝内外胆管结石者；患者能耐受全麻手术。