腹腔镜肝左外叶切除免T管治疗肝内外胆管结石.pdf

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1、48肝胆外科杂志2014年2月第22卷第1期JournalofHepatobiliarySurgery，Vol，22，No．1，Feb．2014腹腔镜肝左外叶切除免T管治疗肝内外胆管结石曾新桃，熊永福，杨培，张伟，罗华，匡铭，邓澜【摘要】目的探查腹腔镜切除肝左外叶联合术中胆道镜免T管治疗肝左外叶胆管结石合并(或不合并)胆囊结石、肝外胆管结石的可行性及安全性。方法回顾性分析15例肝左外叶胆管结石患者的病例资料，其中合并肝外胆管5例，合并胆囊结石6例。采用腹腔镜切除肝左外叶及胆囊，选择左肝管残端为胆道镜进入通道，探查右

2、肝管及肝外胆管，取出肝外胆管结石，缝合左肝断面胆管。结果全部病例得以成功实施，平均手术时间133．6min(110．0—185．0)min，平均术中出血量169．7ml(85．0—355．0)ml，平均术后住院时间7．1d(5．0—9．0)d，术后1例病人出现左肝断面感染，并轻度胆汁漏，带引流管出院，术后28天拔除引流管治愈，平均术后随访时间28．1m(9．0—48．0)m，未见结石残留、复发。结论选择合适的病例开展腹腔镜切除肝左外叶联合术中胆道镜免T管治疗肝左外叶胆管结石合并(或不合并)胆囊结石、肝外胆管结石是安

3、全、可行的。【关键词l腹腔镜；胆道镜；肝内肝管结石；肝切除；胆道探查；免T管【中图分类号】R657．4【文献标识码】A【文章编号】1006-4761(2014)01-0048-03T-Tube-freeLaparoscopicLeftLateralHepatectomyManagementofIntra-orExtrahepaticBileDuctCalculirZENGXin—tao，XIONGy0，YANGPei，eta1．TheCenterHospitalofMianYang，Mianyang621000，C

4、hina)【Abstract】ObjectiveTodiscussthesaltyandfeasibilityforLaparoscopicManagementofIntra—orExtrahepaticBileDuctCalculicombinewithintraoperativeCholangioscopywithoutT·Tubedrainage．MethodsThereare15caseswhosufferingleft—sidedhepatolithiasis，5caseshavecommonbiledu

5、ctstones，and6caseshavegallbladerstonesamongthem．Afterlaparoscopicallylefthepa-tectomy，extrahepaticbileductstonesremovalandfighthepaticductexplorationwerecarriedoutundercholedochoscopethroughthelefthepaticduct．ResultsTheoperationwasaccomplishedsuccessfullyinall

6、cases．Themeanoperationtimewas133．6rain(range，110．0-185．0rain)，andmeanbloodlosswas169．7ml，(range，85．0～355．0m1)．1patientsufferfromlefthepaticcross-sectioninfection，28daysafteroperationthepatientwascured，wepulloutthedrainagetube．The15patientwerefollowedfrom10-48m

7、onth，men11．7month．NoresidualorrecurrentstonewerecheckoBt．ConclusionsWethinkthatintraoperativebiliaryexplorationthroughlefthepat—icductorificeinleft—sidedhepatolithiasispatientsisaneffectiveapproachsimplifyingtheoperationprocedurebyavoidingcholedochoto—myandsub

8、sequentT”tubeinsertion．【Keywords】Laparoscopy；Cholangioseopy；Hepatolithiasis；Hepatectomy；Bileductexploration；T—Tube—free．腹腔镜肝切除手术日趋成熟，腹腔镜肝左外叶(5．0—60．0)月，临床表现为反复腹痛l4例，伴发切除有望成为治疗肝左~bn