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《[13]腹腔镜与胆道镜联合钬激光治疗肝内胆管结石_赵守和.pdf》由会员上传分享,免费在线阅读,更多相关内容在行业资料-天天文库。
1、·1128·中国微创外科杂志2013年12月第13卷第12期ChinJMinInvSurg,December2013,Vol.13.No.12·临床论著·腹腔镜与胆道镜联合钬激光治疗肝内胆管结石*赵守和常永春阎玉矿(深圳市坪山新区人民医院普外科,深圳518118)【摘要】目的探讨腹腔镜与胆道镜联合钬激光治疗肝内胆管结石的临床价值。方法2009年1月~2013年1月,对40例肝内胆管结石行腹腔镜、胆道镜联合钬激光治疗。德国Lumenis公司钬激光器(Holmium:YAG)(波长2.1μm,光导纤芯直径5500μm,光纤最大外径780μm)。结石直径3~
2、15mm。嵌顿型14例,铸状结石10例,游离型结石16例。胆总管一期缝合6例,34例置T管引流。结果40例手术均成功完成,无中转开腹,无死亡。术后并发症6例:切口感染3例,肺部感染1例,胆漏2例,均治愈。术后随访6个月~3年,平均15个月,其中32例>12个月,无胆道残余结石。结论腹腔镜与胆道镜联合钬激光治疗肝内胆管结石具有创伤小,并发症少,可同时发现并处理胆管狭窄,取石率高,残石率低等优点。【关键词】肝内胆管结石;微创技术;钬激光;腹腔镜;纤维胆道镜;碎石中图分类号:R657.4文献标识:A文章编号:1009-6604(2013)12-1128-03
3、**MinimallyInvasiveSurgeryCombinedwithHolmiumLaserforHepatolithiasisZhaoShouhe,ChangYongchun,Yan*Yukuang.DepartmentofGeneralSurgery,PingshanNewDistrictPeople’sHospital,Shenzhen518118,China【Abstract】ObjectiveTosummarizeandanalyzetheclinicaleffectofmini-invasivesurgerycombinedwith
4、holmiumlaserforthetreatmentofhepatolithiasis.MethodsTheclinicaldataof40casesofhepatolithiasisundergoingminimallyinvasivesurgery(laparoscopeandcholedochoscope)combinedwithholmiumlaserwerecollectedfromJanuary2009toJanuary2013inourhospital.Thestoneswere3-15mmindiameter.Sixcaseswere
5、closedbyprimarycommonbileductsuture.Ttubedrainagewasplacedin34cases.ResultsAllthesurgerieswerecompletedsuccessfully,withnoconversiontoopensurgeryordeath.Sixcasessufferedcomplications,including3casesofincisioninfection,1caseoflunginfectionand2casesofbileleakage.Allthe6casesrecove
6、red.Allthecaseswerefollowedupfor6monthsto3yearspostoperatively(average,15months;32casesformorethan12months),andnoresidualstonewasfound.ConclusionsMinimallyinvasivesurgerycombinedwithholmiumlaserforthetreatmentofhepatolithiasisisminimallyinvasiveandhaslesscomplications.Meanwhile,
7、itcanhelpdetectandmanagebileductstenosisandincreasetherateofresidualstoneremoval.【KeyWords】Hepatolithiasis;Minimallyinvasivesurgery;Holmiumlaser;Laparoscope;Fibercholedochoscope;Lithotripsy对肝内胆管结石,传统治疗方法是开腹胆总管本组40例,男18例,女22例。年龄25~79切开探查取石,放置T管及腹腔(文氏孔)引流管。岁,(45.0±13.0)岁。上腹部疼痛病史1~
8、35年,随着内镜外科和微创技术的发展,肝内胆管结石的其中16例有黄疸及发热病史,10例有肝胆疾
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