腹腔镜规则性左半肝切除联合胆道镜取石治疗肝内外胆管结石

目的：探讨腹腔镜下规则性左半肝切除联合胆道镜取石治疗肝左叶肝内胆管结石合并胆总管结石的临床疗效。 方法：回顾性分析2010年3月—2013年9月间收治的12例肝内外胆管结石患者的临床资料。患者术前均明确诊断为左肝内广泛胆管结石合并胆总管结石，均行腹腔镜规则性左半肝切除联合胆总管切开胆道镜取石术。 结果：所有手术均顺利完成，无中转开腹。手术用时（182.6±36.3）min，术中出血（213.5±65.5）mL，术后肛门排气时间（38.5±8.2）h，术后平均住院时间（10.3±3.1）d。术后发生肝断面出血1例，胆瘘1例，均通过保守治疗痊愈。随访时间3个月至3年，平均23个月，未发现胆道结石残留或再生。 结论：对于肝左叶广泛肝内胆管结石合并胆总管结石的患者，腹腔镜规则性左半肝切除联合胆道镜行胆总管切开取石术是安全有效的手术方式。

Laparoscopic anatomic left hemihepatectomy plus choledochoscopic lithotomy for concomitant intra- and extrahepatic bile duct stones

Objective: To investigate the clinical efficacy of laparoscopic anatomic left hemihepatectomy plus choledochoscopic lithotomy in treatment of left intrahepatic bile duct stones with extrahepatic bile duct stones. Methods: The clinical data of 12 patients with concomitant left intra- and extrahepatic bile duct stones admitted from March 2010 to September 2013 were retrospectively analyzed. All patients were definitely diagnosed having extensive stones in the left hepatic lobe and concomitant common bile duct stones, and all patients underwent laparoscopic anatomic left hemihepatectomy combined with choledochoscopic choledocholithotomy. Results: All operations were successfully completed without any open conversion. The operative time was (182.6±36.3) min, intraoperative blood loss was (213.5±65.5) mL, time to postoperative flatus was (38.5±8.2) h, and length of postoperative hospital stay was (10.3±3.1) d. Bleeding from the cut liver surface and bile leakage occurred in one case each after operation, which were all resolved by conservative treatment. Over a follow-up of 3 months to 3 years with an average of 23 months, no residual stones or new stone formation were found. Conclusion: Laparoscopic anatomic left hemihepatectomy plus choledochoscopic lithotomy is an effective and safe procedure for patients with extensive stones in the left hepatic lobe and concomitant common bile duct stones.