摘要
目的探讨腹腔镜超声辅助精准肝切除治疗肝内外胆管结石的临床价值。方法回顾性分析2014年5月至2019年1月杭州市富阳区第一人民医院行腹腔镜下肝切除的肝胆管结石52例患者资料,其中男性28例,女性24例,中位年龄56.0岁。术中运用腹腔镜超声对结石的位置、大小、分布及血管分布情况作预先探查及超声引导肝切除。43例采用解剖性肝切除技术完成精准肝切除,胆道镜辅助取石38例,根据术中情况置"T"管。结果50例成功完成手术,2例因术中粘连出血中转开腹手术。术中运用腹腔镜超声发现肝内钙化5例,经肝断面胆道镜取石2例。术后并发腹腔积液脓肿5例。患者手术时间(289.0±132.0)min,术中出血(451.0±256.0)ml,术后住院时间(12.0±3.0)d。52例患者4例结石残留,残留率7.7%,均于术后8周经T管窦道完全取出。结论采用腹腔镜超声能预知重要管道分布,减少患者术中出血机会,有助于明确结石位置和分布,提高术中肝内外胆管结石的诊断精确性,减少不必要的肝切除和肝内外胆管结石的残留率,提高手术安全性。
Objective To study laparoscopic ultrasound assisted hepatectomy in treatment of intrahepatic and extrahepatic bile duct stones.Methods The data of 52 patients with hepatolithiasis who underwent laparoscopic hepatectomy from May 2014 to January 2019 at the Fuyang District First People's Hospital in Hangzhou were analyzed retrospectively.There were 28 men and 24 women.The median age was 56 years.Operative laparoscopic ultrasonography was used to detect the location,size,distribution of stones and their relations to blood vessels.A total of 43 patients underwent anatomic hepatectomy,while 38 patients underwent choledochoscopic stone extraction.A"T"tube was used according to intraoperative conditions.Results Laparoscopic surgery was successfully carried out in 50 patients,while conversion to open surgery was required in 2 patients because of adhesions and bleeding.Laparoscopic ultrasonography revealed intrahepatic calcifications in 5 patients and choledochoscopy in 2 patients.Postoperative complications included 5 patients who devleoped abdominal abscesses.The operation time was(289.0±132.0)minutes.The intraoperative blood loss was(451.0±256.0)ml.The hospitalization after operation was(12.0±3.0)days.In 52 patients,4 patients had residual stones and the residual rate was 7.7%.All of them were completely removed by T-tube sinus 8 weeks after operation.Conclusions Laparoscopic ultrasound helped to detect relevant bile ducts containing stones,reduced chance of bleeding in surgery,helped to clarify location and distribution of stones,improved accuracy of diagnosis,and reduced unnecessary hepatectomy by clearly defining intrahepatic bile duct stones intraoperatively.The residual intrahepatic and intrahepatic bile duct stones rates were reduced,and the safety and accuracy of the operations were improved.
作者
李国伟
蔡剑锋
袁年勇
喻祖胜
温怡洪
章俊杰
丁伟
夏群峰
Li Guowei;Cai Jianfeng;Yuan Nianyong;Yu Zusheng;Wen Yihong;Zhang Junjie;Ding Wei;Xia Qunfeng(Department of Hepatobiliary and Pancreatic Surgery,the First People's Hospital of Fuyang District,Hangzhou 311400,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2019年第9期685-688,共4页
Chinese Journal of Hepatobiliary Surgery
基金
浙江省杭州市科技局重点临床应用项目(20150733Q70)。
关键词
腹腔镜检查
超声检查
肝切除术
腹腔镜超声
精准外科
胆管结石
Laparoscopy
Ultrasonography
Hepatectomy
Laparoscopic ultrasound
Precise surgery
Bile duct stone
