Li T, Cui L, Wang G, Ling X F, Hou C S, Wang L X, Xu Z
Department of General Surgery, Peking University Third Hospital, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2016 Oct 18;48(5):915-918.
To investigate the effect and feasibility of total laparoscopy to treat hepatolithiasis using gallbladder-hepatic duct subcutaneous tunnel. Retrospective analysis was conducted of the case data of 11 patients with hepatolithiasis who underwent total laparoscopic treatment using gallbladder-hepatic duct subcutaneous tunnel from January 2010 to October 2014. The operation time, blood loss, postoperative complications and recurrence of stones were recorded.All the cases completed the operation.The average hospital-stay was 9.2 days (range: 3-29 d). The average operation time was 298 min (range: 225-480 min). The average blood loss was 253 mL (range: 50-700 mL), and the average blood loss of liver resection groups was 325 mL (range: 200-700 mL). The average discharge time was 3.3 days (range: 3-5 d). The rate of postoperative residual stones was 36.4% (4/11).We extracted stones with choledochofiberscope via T-tube sinus six weeks after operation. One case developed biliary leakage, and healed through adequate drainage and the T-tube was pulled out after one month. There was no perioperative mortality. All the cases were followed up and the mean follow-up was 22 months (range: 2-51 months). The anastomotic stenosis of gallbladder-hepatic duct was found in one case. But we got a good therapeutic result with performed gallbladder chemical ablation with 95% ethanol. No recurrence of hepatolithiasis was found. As a choice for minimally invasive method to hepatolithiasis using gallbladder-hepatic duct subcutaneous tunnel,total laparoscopy is a safe and feasible procedure.
探讨完全腹腔镜下经胆囊 - 肝管皮下隧道治疗肝内胆管结石的疗效及可行性。回顾性分析2010年1月至2014年10月期间11例行完全腹腔镜下经胆囊 - 肝管皮下隧道治疗肝内胆管结石患者的病例资料,记录手术时间、出血量、术后并发症及结石复发情况。所有病例均完成手术,平均住院时间为9.2天(范围:3 - 29天)。平均手术时间为298分钟(范围:225 - 480分钟)。平均出血量为253毫升(范围:50 - 700毫升),肝切除组平均出血量为325毫升(范围:200 - 700毫升)。平均出院时间为3.3天(范围:3 - 5天)。术后残余结石率为36.4%(4/11)。术后6周经T管窦道行纤维胆道镜取石。1例发生胆漏,经充分引流后愈合,1个月后拔除T管。无围手术期死亡。所有病例均获随访,平均随访时间为22个月(范围:2 - 51个月)。1例发现胆囊 - 肝管吻合口狭窄,经95%乙醇行胆囊化学消融后取得良好治疗效果。未发现肝内胆管结石复发。完全腹腔镜下经胆囊 - 肝管皮下隧道作为肝内胆管结石的一种微创治疗方法,是安全可行的。