腹腔镜经左肝断面胆管行硬质胆道镜探查胆总管取石的研究

【摘要】 目的 对比腹腔镜肝左外叶切除后经左肝断面胆管行硬质胆道镜胆总管探查与腹腔镜肝左外叶切除、胆总管探查、T管引流术在治疗胆总管合并左肝外叶胆管结石的疗效,探讨前者的可行性、安全性。方法〓将我院2011年11月~2014年11月收治的59例行胆总管结石合并左肝外叶胆管结石患者根据手术方式分为观察组和对照组,观察组(n=32)采用经肝断面行硬质胆道镜探查胆总管取石;对照组(n=27)采用肝左外叶切除胆总管切开胆道镜探查取石及T管引流术,比较两组的手术时间、手术出血量、结石取出情况、术后肛门排气时间、术后住院时间、并发症发生率以及WBC、CRP、肝功能Child-Pugh评分、ICG R15等指标。结果〓两组患者手术出血量、结石取出情况、术后肛门排气时间、术后并发症总发生率、术后第1、5天WBC、CRP、肝功能Child-Pugh评分、ICG R15等比较,差异无统计学意义(P>0.05);两组中,观察组的平均手术时间、术后住院时间少于对照组,差异有统计学意义(P<0.05)。结论〓腹腔镜肝左外叶切除后经左肝断面胆管行硬质胆道镜探查胆总管取石在治疗胆总管合并左肝外叶胆管结石,在临床上是可行、安全有效的,具有很好的临床应用价值。

Clinical study of laparoscopic treatment of common bile duct stones with rigid bile duct in the left hepatic section

【Abstract】〓Objective〓To investigate the clinical effects of treatment of common bile duct and left hepatic duct stones by way of laparoscopic hepatectomy and choledochotomy through the left hepatic section by rigid choledochoscopy,.and to explore the feasibility and safety. Methods〓Fifty-nine cases of common bile duct stones combined with left hepatic duct stones from Nov. 2011 to Nov. 2014 were assigned to observation group (32 cases) and control group (27 cases). The patients in observation group underwent laparoscopic left lateral external lobectomy and common bile duct exploration with rigid choledochoscope via bile duct of liver section, and those in control group received laparoscopic left lateral external lobectomy and common bile duct exploration with T tube placement. The operation time, blood loss, postoperative bleeding, postoperative anal exhaust time, postoperative hospital stay,.postoperative complications were compared between two groups..WBC score,.Child-Pugh score,.R15 ICG were also investigated. Results〓There were not statistical differences between two groups of patients in blood loss,.removal the stones,.postoperative anal exhaust time,.postoperative pain,.postoperative complications,.the WBC,.liver function Child-Pugh score, R15 ICG after the first, five days. But the average operating time, postoperative hospitalization time of observation group were less than that of control group (P<0.05). Conclusion〓The surgical procedure, common bile duct exploration via bile duct from liver cross section after left lateral lobectomy, showed a feasible and safe way for treatment of common bile duct stones and hepatic duct stone.