Cui Long, Xu Zhi, Ling Xiao-Feng, Wang Li-Xin, Hou Chun-Sheng, Wang Gang, Zhou Xiao-Si
Long Cui, Zhi Xu, Xiao-Feng Ling, Li-Xin Wang, Chun-Sheng Hou, Gang Wang, Xiao-Si Zhou, Department of General Surgery, Peking University Third Hospital, Beijing 100191, China.
World J Gastroenterol. 2014 Mar 28;20(12):3350-5. doi: 10.3748/wjg.v20.i12.3350.
To investigate the feasibility, efficacy and safety of laparoscopic hepaticoplasty using gallbladder as subcutaneous tunnel and sphincter-of-Oddi preservation for hepatolithiasis.
From January 2010 to July 2013, six patients with hepatolithiasis were treated at our institution. All the patients underwent laparoscopic surgery. The procedures included common hepatic duct exploration, stone clearance by fiberoptic choledochoscopy, hilar bile duct hepaticoplasty with preservation of the sphincter of Oddi, anastomosis between the hilar bile duct and neck of the gallbladder, and establishment of a subcutaneous tunnel with the gallbladder. Two patients underwent left lateral hepatectomy simultaneously. Clinical data including operation time, intraoperative blood loss, operative morbidity, hospital mortality, stone clearance, and recurrence rate were analyzed.
All patients successfully completed laparoscopic surgery. The mean length of hospital stay was 4.5 ± 0.9 d (range: 3-6 d). The mean blood loss of the hepatectomy was 450 mL (range: 200-700 mL), and the blood loss of the other four was 137 ± 151 mL (range: 50-400 mL). The mean operative time was 318 ± 68 min (range: 236-450 min). The operative morbidity and hospital mortality were zero. The immediate stone clearance rate was 100%. All patients were followed up for an average of 17 mo (range: 7-36 mo). One of the six patients had abdominal mass with pain, and subcutaneous tunnel cholangiography showed severe gallbladder-biliary anastomotic stricture at 4 mo postoperatively. There was no stone recurrence and no cholangitis during follow-up.
Laparoscopic hepaticoplasty using gallbladder with a subcutaneous tunnel and preserving the sphincter of Oddi is feasible, safe and effective for hepatholithiasis.
探讨以胆囊为皮下隧道并保留Oddi括约肌的腹腔镜肝成形术治疗肝内胆管结石的可行性、疗效及安全性。
2010年1月至2013年7月，我院收治6例肝内胆管结石患者。所有患者均接受腹腔镜手术。手术步骤包括肝总管探查、纤维胆道镜取石、保留Oddi括约肌的肝门部胆管成形术、肝门部胆管与胆囊颈部吻合以及用胆囊建立皮下隧道。2例患者同时行左肝外叶切除术。分析手术时间、术中出血量、手术并发症、医院死亡率、结石清除率及复发率等临床资料。
所有患者均成功完成腹腔镜手术。平均住院时间为4.5±0.9天（范围：3 - 6天）。肝叶切除患者平均出血量为450毫升（范围：200 - 700毫升），另外4例患者出血量为137±151毫升（范围：50 - 400毫升）。平均手术时间为318±68分钟（范围：236 - 450分钟）。手术并发症及医院死亡率为零。即时结石清除率为100%。所有患者平均随访17个月（范围：7 - 36个月）。6例患者中有1例术后4个月出现腹部肿块伴疼痛，皮下隧道胆管造影显示胆囊 - 胆管吻合口严重狭窄。随访期间无结石复发及胆管炎发生。
以胆囊为皮下隧道并保留Oddi括约肌的腹腔镜肝成形术治疗肝内胆管结石可行、安全且有效。
