腹腔镜、胆管镜、扩张导管、T管支架治疗肝左外叶及胆总管结石17例

目的探讨腹腔镜、胆管镜、扩张导管(逐级扩张导管、球囊导管)、T管支架(T形管＋塑料胆管支架，LCDTS)治疗肝左外叶及胆总管结石的应用体会。 方法回顾性分析2002年4月至2017年9月间符合入选标准的17例患者的临床资料。 结果腹腔镜下切除肝左外叶和探查胆总管17例，切除胆囊12例。胆管镜取石、逐级导管扩张左肝管和乳头并留置LCDTS 52.9% (9/17)，逐级导管扩张左肝管和推挤左肝管结石出总管切口并留置LCDTS 23.5% (4/17)，逐级导管联合球囊导管扩张左肝管并留置LCDTS 11.8%(2/17)，因肝内胆管残石和狭窄扩张左肝管并留置LCDTS 11.8% (2/17)。术后残石2例(11.8%)，胆汁漏1例(5.9%)。无肠穿孔、胆管穿孔、大出血、急性胰腺炎等并发症，无围手术期再手术和死亡患者。术后总并发症发生率为17.6%(3/17)。 结论只要病例选择合适，LCDTS治疗肝左外叶及胆总管结石是可行、有效和安全的。

Treament by laparoscopy,choledochoscopy, dilatable catheter,T tube and plastic biliary stent drainage on the left lateral lobe hepatic duct and common bile duct stones: a report of 17 cases

ObjectiveTo explore the surgical technique and clinical effect of laparoscopy, choledochoscopy, dilatable catheter, T tube and plastic biliary stent drainage (LCDTS) for the treatment of the left lateral lobe hepatic duct and common bile duct stones. MethodsThe clinical data of 17 cases of the left lateral lobe hepatic duct and common bile duct stones treated with LCDTS were analyzed retrospectively from April 2002 to September 2017 in the Second People’s Hospital of Chengdu. ResultsLaparoscopic hepatic left lateral lobectomy and common bile duct exploration was proformed in all the 17 cases, laparoscopic cholecystectomy was proformed in 12 cases. Through the duct incision with choledochoscopy to remove gallstones, step by step dilatable catheter expanded left hepatic duct and duodenal papilla and indwelling T tube and plastic biliary stent drainage of left hepatic duct was proformed in 9 cases; push the stones into the common hepatic duct and indwelling T tube and plastic biliary stent drainage of left hepatic duct was proformed in 4 cases; step by step dilatable catheter combining balloon catheter expanded left hepatic duct and duodenal papilla and indwelling T tube and plastic biliary stent drainage of left hepatic duct was proformed in 2 cases; through choledochoscopic examination indwelling T tube and plastic biliary stent drainage of left hepatic duct due to residual stone and stenosis of the intrahepatic bile duct was proformed in 2 cases. Residual stone was occurred after T tube and plastic biliary stent drainage in 2 cases. Bile leakage was found in 1 case. No cases of perforation of intestine and bile duct, bleeding, acute pancreatitis were found. No cases of perioperative reoperation and death were found. The total postoperative complication formation rate was in 17.6%. ConclusionIf patients are suitable, LCDTS for treatment of the left lateral lobe hepatic duct stones and common bile duct stones is safe and effective.