免T管腹腔镜辅助肝切除治疗肝内外胆管结石11例

目的 探讨不放置T管的腹腔镜辅助肝切除治疗肝内外胆管结石的可行性和安全性。方法 11例左肝内胆管结石，其中合并胆总管结石8例，胆囊结石5例。采用腹腔镜辅助规则肝切除，均经左肝管残端插入电子胆道镜肝外胆管取石和右肝管探查，不切开胆总管，不放置T管引流。结果 11例手术均获得成功，其中腹腔镜辅助肝左外叶切除5例，左半肝切除6例。手术时间110～150min，平均128min；术中出血50～150ml，平均95ml。术后无并发症。术后住院5～10d，平均7d。11例随访2～16个月，平均7．6月，优10例，良1例，无结石残留、复发。结论 腹腔镜辅助左肝切除、经左肝管残端胆道镜取石，不放置T管，有利于降低手术难度，缩短手术时间，减少并发症，是可供选择的手术方式。

Treatment of hepatolithiasis by laparoscopically assisted hepatectomy without T-tube drainage

Objective To study the feasibility and safety of laparoscopically assisted hepatectomy without choledochotomy and T-tube drainage for the treatment of hepatolithiasis.Methods The study included 11 patients with hepatolithiasis in the left intrahepatic duct.Of the 11 patients,8 patients were complicated with choledocholith and 5 patients with cholecystolithiasis.After laparoscopically assisted left hepatectomy,extrahepatic bile duct stone removal and right hepatic duct exploration were carried out under video-assisted choledochoscopy through the left hepatic duct,without choledochotomy and T-tube drainage.Results The operation was successfully accomplished in all the 11 patients.Liver procedures included laparoscopically assisted left lateral lobectomy in 5 patients and left hemihepatectomy in 6 patients.The mean operation time was 128 min(range,110~150 min),and the mean blood loss was 95 ml(range,50~150 ml).No serious postoperative complications occurred.The mean postoperative hospital stay was 7 d(range,5~10 d).The 11 patients were followed for a mean of 7.6 months(range,2~16 months).The curative effects were classified as excellent in 10 patients and good in 1.No residual or recurrent stones were noted.Conclusions Laparoscopically asisted hepatectomy without T-tube drainage for the treatment of hepatolithiasis is feasible and safe for selected patients.This procedure offers advantages of simplicity of performance,short operation time,and fewer complications,being a worthwhile minimally invasive alternative.