肝内胆管结石的微创治疗

目的探讨微创洽疗肝内胆管结石的方法、可行性及疗效。方法总结2006年5月至2012年11月采用完全腹腔镜治疗肝内胆管结石15例。手术方式包括腹腔镜单纯肝脏切除、腹腔镜单纯胆道探查取石，或者联合保留Oddi括约肌的皮下通道胆囊或游离空肠肝胆管成形术。结果所有患者均成功完成手术，无围手术期死亡，术后残留结石率26％（4／15）。所有患者均获得随访，随访率100％。平均随访29个月（2～80个月），术后吻合口狭窄l例，未见结石复发。结论认真掌握手术适应证，仔细操作，合理利用胆道镜及皮下通道，可实现肝内胆管结石的微创治疗。

A study of minimally invasive treatment for hepatolithiasis

Objective To investigate the feasibility and therapeutic effect of minimally invasive treatment for hepatolithiasis. Methods An investigation was conducted in 15 patients with hepatolithiasis who underwent total laparoscopic treatment from May 2006 to November 2012. The procedures included simple laparoscopic hepatectomy, simple laparoscopic bile duct exploration, and Oddi sphincter -preserved subcutaneous tunnel and hepatocholangioplasty with the use of gallbladder or free jejunum. Results All cases completed the operation, with no perioperative mortality, and postoperative residual stones were found in 26% of all cases （4/15）. The follow - up rate was 100% ; the mean follow - up was 29 months （ range, 2 - 80 months）. There was one case of postoperative anastomotic stenosis, and no recurrence of hepatolithiasis was seen. Conclusion Minimally invasive treatment for hepatolithiasis can be achieved if the operative indications are fully understood, the procedures are carefully performed, and the choledochoscope and subcutaneous tunnel are properly used.