Department of Surgery, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Rd., Chai Wan, Hong Kong SAR, China.
Am J Surg. 2010 May;199(5):716-21. doi: 10.1016/j.amjsurg.2009.02.007. Epub 2009 Dec 3.
The aim of the current study was to evaluate the perioperative and long-term outcome of a laparoscopic approach for management of primary hepatolithiasis.
From January 1995 to June 2008, 55 consecutive patients with primary hepatolithiasis who underwent laparoscopic partial hepatectomy and laparoscopic bile duct exploration were analyzed. Immediate outcomes included stone clearance rate, operative morbidity, and mortality. Long-term outcomes included stone recurrence rate and hepatolithiasis-related mortality.
Nineteen patients underwent laparoscopic left lateral sectionectomy and 36 patients underwent laparoscopic bile duct exploration. Twenty-five patients also underwent concomitant laparoscopic choledochoduodenostomy bypass. The operative morbidity and mortality rates were 25.5% and 1.8%, respectively. Four procedures needed open conversion. The immediate stone clearance rate was 90.9%, and the final stone clearance rate was 94.5% after subsequent choledochoscopic treatment. With a mean follow-up of 59 +/- 30 months, recurrent stones developed in 3 patients. One patient died of advanced cholangiocarcinoma.
In selected patients with primary hepatolithiasis, a laparoscopic approach of definitive treatment is safe and effective with good immediate and long-term outcomes.
本研究旨在评估腹腔镜治疗原发性肝胆管结石的围手术期和长期疗效。
1995 年 1 月至 2008 年 6 月，55 例原发性肝胆管结石患者接受了腹腔镜肝部分切除术和腹腔镜胆管探查术，分析其即刻疗效，包括结石清除率、手术并发症发生率和死亡率。长期疗效包括结石复发率和肝胆管结石相关死亡率。
19 例患者接受了腹腔镜左半肝切除术，36 例患者接受了腹腔镜胆管探查术。25 例患者还接受了腹腔镜胆总管十二指肠吻合术。手术并发症发生率和死亡率分别为 25.5%和 1.8%。4 例手术需要转为开放性手术。即刻结石清除率为 90.9%，经后续胆道镜治疗后最终结石清除率为 94.5%。平均随访 59±30 个月，3 例患者复发结石，1 例患者死于晚期胆管癌。
在选择合适的原发性肝胆管结石患者中，腹腔镜确定性治疗安全有效，具有良好的即刻和长期疗效。
