摘要
目的探讨肝内外胆管结石的腹腔镜肝切除术联合内镜治疗的方法。方法选择自2004年7月至2008年3月收治的81例肝内、外胆管结石患者,随机选择20例患者行开腹胆道探查+肝切除术作为对照组,其余61病例作为实验组,先行十二指肠镜取石治疗。对于肝外胆管结石取石成功者,根据肝内结石位置,行完全腹腔镜下肝切除和手助腹腔镜肝切除术;对于肝外胆管结石无法取净者,行腹腔镜肝切除+胆道探查术。对微创治疗组和开腹对照组围手术期相关指标进行观察分析。结果对于肝内、外胆管结石患者根据具体情况实施相应的微创治疗方案,术后恢复顺利,无严重术后并发症。微创治疗组和开腹对照组相比,在手术时间、术中出血量无统计学差异(P>0.05),但术后肠道功能恢复快(P<0.05)。结论腹腔镜肝切除术联合内镜治疗肝内外胆管结石是一种安全有效的方法,它能最大限度地减少对患者创伤,充分体现了内镜、腹腔镜联合治疗的优越性。该方法对于内镜、腹腔镜技术较高的医疗单位是切实可行的。
Objective To study the approach of combination oflaparoscopic liver resection and endoscopy in the treatment of intrahepatolithiasis and extrahepatic bile duct stone disease.Methods From Jul.2004 to Mar.2008,totally patients with intrahepatolithiasis and extrahepatic bile duct stones were admitted and received the therapeutical procedures according to the different sorts and degrees of patients with biliary calculi.Twenty cases were rando mly selected to perform open hepatectomy and and T-tube drainage for case-control study.The rest cases were underwent the treatment of duodenoscopy at first.Then, according to the outcomes of the treatment of endoscopy and the special conditions of intrahepatolithiasis and extrahepatic bile duct stone disease,we proposed a series of schemes,i.e.,a scheme of total laparoscopic hepatectomy,one of hand-assisted laparoscopic hepatectomy and one of hand-assisted laparoscopic hepatectomy and co mmon bile duct exploration.The related indexes in perioperative period of the mini-invasive treatment group were observed and analyzed compared with the outcome of the control group. Results We have perfromed the corresponding mini-invasive schemes for various conditions of intrahepatolithiasis and extrahepatic bile duct stone disease.Satisfactory outcomes were obtained.There were not serious post-operative complications.There were no significant difference of surgical average operation time and intraoperative blood loss between the two groups（P0.05）.Compared with the control group,the time of GI function recovery in the mini-invasive surgical treatment group was faster. Conclusions Combination of laparoscopic liver resection and endoscopy is safe and feasible for the patients with intrahepatolithiasis and extrahepatic bile duct stone disease.It tilizes the advantages of techniques of digestive endoscopies and laparoscopy and shows fully the characteristics of mini-invasive surgical means.
出处
《中华腔镜外科杂志（电子版）》
2008年第2期80-84,共5页
Chinese Journal of Laparoscopic Surgery(Electronic Edition)
关键词
腹腔镜
内镜
肝切除术
肝内外胆管结石
Laparoscopy
Endoscopy
Hepatectomy
Intrahepatolithiasis and Extrahepatic bile duct stone Disease
