腹腔镜与胆道镜联合钬激光治疗肝内胆管结石

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2.1 μm,光导纤芯直径5500 μm,光纤最大外径780 μm）.结石直径3-15 mm.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.

Minimally Invasive Surgery Combined with Holmium Laser for Hepatolithiasis

Objective To summarize and analyze the clinical effect of mini-invasive surgery Combined with holmium laser for the treatment of hepatolithiasis. Methods The clinical data of 40 cases of hepatolithiasis undergoing minimally invasive surgery （laparoscope and choledochoscope） combined with holmium laser were collected from January 2009 to January 2013 in our hospital. The stones were 3 - 15 mm in diameter. Six cases were closed by primary common bile duct suture. T tube drainage was placed in 34 cases. Results All the surgeries were completed successfully, with no conversion to open surgery or death. Six cases suffered complications, including 3 cases of incision infection, 1 case of lung infection and 2 cases of bile leakage. All the 6 cases recovered. All the cases were followed up for 6 months to 3 years postoperatively （average, 15 months; 32 cases for more than 12 months） , and no residual stone was found. Conclusions Minimally invasive surgery combined with holmium laser for the treatment of hepatolithiasis is minimally invasive and has less complications. Meanwhile, it can help detect and manage bile duct stenosis and increase the rate of residual stone removal.