关键词: 肝胆管结石, 腹腔镜, 胆管树流域, 胆管狭窄

Abstract: Difficulties and countermeasures in the treatment of complex hepatolithiasis using laparoscopic technique                 ZHENG Shu-guo*, WANG Xing-ru. *Institute of Hepatobiliary Surgery of the Army, Southwest Hospital, Army Medical University, Chongqing 400038, China 
Corresponding author： ZHENG Shu-guo,E-mail:shuguozh@163.com
Abstract    In recent years, with the advancement of laparoscopic technology and the in-depth understanding of the clinicopathological characteristics of hepatolithiasis, especially the integration of concepts and technologies such as precision surgery, digital medicine, and accelerated recovery surgery, the laparoscopic surgical treatment of hepatolithiasis has gradually become standardized and precise. At present, although there are some difficulties and controversies in the application of laparoscopic technology in the treatment of complex hepatolithiasis, it is generally safe and feasible, and has certain short-term advantages and wide application prospects. The key to the success of the operation is the correct selection of surgical indications, comprehensive and detailed preoperative evaluation, and surgical planning, taking the concept of precise diseased bile duct tree territory resection as the core, following the standardized surgical procedures, mastering the techniques of laparoscopic liver resection, hilar bile duct plastic-anastomosis and choledochoscopy stone removal, and reasonably selecting and applying intraoperative ultrasound, ICG fluorescence staining, augmented/mixed reality and other auxiliary technologies.

Key words: hepatolithiasis, laparoscopy, bile duct tree territory, bile duct stenosis