微创治疗肝硬化患者肝内外胆管结石探讨

目的探讨微创疗法在治疗合并有肝硬化的肝内外胆管结石患者的疗效及应用价值。方法总结2008年1月-2012年12月,行腹腔镜胆道镜引导下钬激光碎石治疗的肝内外胆管结石的患者,根据是否合并有肝硬化,分为两组,其中合并有肝硬化的患者为肝硬化组,患者数目为16例;无合并肝硬化的肝内外胆管结石患者为对照组,患者数目为42例。对于合并有肝硬化的患者进行术前Child-Pugh分级,对于C级的患者进行保肝、消除腹水等综合治疗后,尽量纠正肝功能为B级或A级,然后两组患者均进行腹腔镜胆道镜引导下钬激光碎石治疗,然后比较两组患者的手术资料：手术时间、术中出血量、术中中转开腹的手术例数、住院天数、胆道出血例数、胆瘘的例数、结石残留情况、胆汁性腹膜炎例数及胆管狭窄等指标。结果肝硬化组患者的结石残留明显多于对照组（P〈0.05）,经T管窦道胆道镜取石后均清除干净,此时的残石率无明显区别,两组患者的手术时间、术中出血量、术中中转开腹例数、住院天数、胆道出血、胆瘘、胆汁性腹膜炎及胆管狭窄等指标无显著性意义。结论该微创疗法同样适合于合并有肝硬化的肝内外胆管结石患者。

Studies of patients with liver cirrhosis in the treatment of intrahepatic and extrahepatic lithiasis by mini-invasive surgical operation

Objective To investigate the therapeutic effect and application value in the patients with liver cirrhosis under the treatment of mini-invasive surgical operation. Methods Summary from Jan. 2008 to Dec. 2012, under the treatment of intrahepatic and extrahepatic lithiasis by laparoscopy with choledochoscope and the holmium laser, patients who depending on whether the merger with cirrhosis divided into two groups, one group associated with cirrhosis of liver cirrhosis patients is the cirrhosis group, there are 16 patients in this group, another group is control group which without liver cirrhosis, there are 42 patients in this group. For patients with cirrhosis associated with preoperative Child-Pugh classification, if the patients were Class C liver, eliminate comprehensive treatment of ascites, etc. , try to correct the liver function is B or A-level, and then the patients were under the guidance of laparoscopy with choledochoscope and the holmium laser. Then compare the data in two groups of patients with surgery, such as operation time, blood loss in operation, and the number of cases of intraoperative transit laparotomy surgery, the number of days in hospital, the cases of hemobilia, the number of patients with biliary fistula, residual stones case, the number of cases of bile peritonitis and the bile duct stricture. Results Cirrhotic patients with residual stones group than the control group significantly （P 〈 0.05 ）, and iqually when residual stones were settled via T pipe, two groups of patients operative time, blood loss, intraoperative conversion to open cases, days of hospitalization, biliary tract bleeding, biliary fistula, bile peritonitis and bile duct stenosis showed no significant. Conclusion The mini-invasive surgical operation can also suitable for intrahepatic and extrahepatic lithiasis patients with cirrhosis.