完全腹腔镜肝切除术中顺行胆道镜检查的临床应用

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1、完全腹腔镜肝切除术中顺行胆道镜检查的临床应用作者：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

2、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11【Abstract】ObjectiveTointroducethetechniqueanddiscussthevaluesofgradecholedochoscopyduringto

3、tallaparoscopicliverresections.MethodsFromJune2002toDecember2005,11casesofhepatolithiasisintheleftintrahepaticductunderwenttotallaparoscopicliverresectionsinourdepartment.Afterlefthepatectomy,videoassistedcholedochoscopywasplacedthroughthelefthepaticducttoexplorethecommonbileductan

4、dtherighthepaticductinordertoremovethestones.Thestumpofthelefthepaticductwassealedpostoperation.ResultsTheoperationwassuccessfullydoneinall11casesincluding6cases(combinedwithcholecystectomyin3cases)treatedwithleftlaterallobetectomyand5(combinedwithcholecystectomyin1case)treatedwithl

5、efthemihepatectomy.Thecholedochoscopywasusedtowashbileductin5casesandremovestonesin5including3withcommonbileductstonesand2withrighthepaticductstones.Onecaseconvertedtobileductplastyafterastricturewasfoundattheoriginationoftherighthepaticduct.Themeanoperationtimewas(201.4±57.5)minute

6、s(105255minutes)andthemeanintraoperativebloodloss(136.4±68.6)ml(50250ml).Thereinto,themeantimeofcholedochoscopywas(42.3±1112.1)minutes(2560minutes).Thepostoperativehospitalstaywas(4.6±1.6)days(38days).Thefollowupfor(22.5±11.6)monthsshowedthattheresultwasexcellentin9casesandgood

7、in2.ConclusionsGradecholedochoscopythroughlefthepaticbileductduringlaparoscopichepatectomyisasafeandfeasiblemethodforhepatolithiasisintheleftintrahepaticduct,foritcanavoidplacementofTtube,shortenrecoverytimeandalleviatethepainofthecases.【Keywords】Laparoscopichepatectomy;Hepatolithi

8、asis;Choledochoscop