中国实用外科杂志

中国实用外科杂志 ›› 2024, Vol. 44 ›› Issue (03): 320-325.DOI: 10.19538/j.cjps.issn1005-2208.2024.03.17

• 论著 • 上一篇    下一篇

腹腔镜超声引导下肝切除术治疗复发肝胆管结石高位狭窄临床研究

陶计林，胡铭语，朱建交，李敬东   

  1. 川北医学院附属医院肝胆外科  川北医学院肝胆胰肠疾病研究所，四川南充 637000
  • 出版日期:2024-03-01 发布日期:2024-04-07

  • Online:2024-03-01 Published:2024-04-07

摘要： 目的    探讨腹腔镜超声（LUS）引导下肝部分切除术在治疗复发肝胆管结石高位狭窄中的临床应用价值。方法    回顾性分析2021年1月至2023年1月川北医学院附属医院行腹腔镜肝切除术的29例肝胆管结石病人临床资料。所有病人均有既往胆道手术史，根据是否使用LUS分为观察组（13例）及对照组（16例）。在手术过程中，观察组利用LUS技术确定肝内胆管结石的位置、胆管狭窄的区域以及肝内胆管和血管的走向。同时，在切除肝实质或显露肝门时，使用LUS技术实时监测胆管狭窄和扩张部位，并结合胆道镜对剩余肝叶内的胆管进行探查和取石。结果    两组病人在手术时间［（333.3±62.11）min vs.（332.9±82.0）min，P=0.989］、术中出血量［（241.5±151.3）mL vs.（341.9±232.9）mL，P=0.192］、术后并发症发生率（30.8% vs. 43.8%，P=0.702）、术后结石残余（7.7% vs. 31.3%，P=0.183）、结石复发（0 vs. 18.8%，P=0.232）差异无统计学意义，两组病人既往手术次数差异有统计学意义（P＜0.05）。结论    LUS有助于明确肝胆管结石的位置、范围、胆管狭窄的部位以及重要血管的走行情况，对于多次胆道手术史的病人术中操作予以实时指导及辅助。

关键词: 复杂肝胆管结石病, 腹腔镜超声, 胆管狭窄

Abstract: Ultrasound-guided laparoscopic surgery for recurrent hepatolithiasis with hilar and intrahepatic bile duct stenosis: A research study        TAO Ji-lin， HU Ming-yu， ZHU Jian-jiao， et al. Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College， Institute of Hepato-Biliary-Pancreatic-Intestinal Disease, North Sichuan Medical College， Nanchong 637000， China
Corresponding author： LI Jing-dong，E-mail:lijingdong358@126.com
Abstract    Objective    Discussing the clinical application value of laparoscopic ultrasound-guided partial hepatectomy in treating recurrent hepatolithiasis with hilar and intrahepatic bile duct stenosis. Methods    A retrospective analysis of clinical data was conducted on 29 patients with hepatobiliary duct stones who underwent laparoscopic hepatectomy at North Sichuan Medical College Affiliated Hospital from January 2021 to January 2023. All patients had a history of previous biliary surgery, According to whether laparoscopic ultrasound was used, the patients were divided into an observation group（13 cases）and a control group（16 cases）. During the surgery, laparoscopic ultrasound was used to precisely locate intrahepatic biliary stones, identify areas of bile duct stenosis, and determine the course of intrahepatic bile ducts and blood vessels. Simultaneously, while resecting liver tissue or exposing the hepatic hilum, we employed real-time laparoscopic ultrasound to monitor bile duct stenosis and dilations, complemented by cholangioscopy for exploration and stone retrieval within the remaining liver lobes.Results    There was no significant difference in operation time ［（333.3±62.11）min vs.（332.9 ± 82.0） min,P=0.989］,intraoperative blood loss ［（241.5±151.3）mL vs.（341.9 ± 232.9） mL,P=0.192］,postoperative complications （30.8%）vs.（43.8%）, P=0.702, postoperative residual stones 7.7% vs. 31.3%,P=0.183, stone recurrence 0 vs. 18.8%, P=0.232 between the two groups. There was a significant difference in the number of previous operations between the two groups（P＜0.05）.Conclusion    Laparoscopic ultrasound is helpful in clarifying the location and scope of hepatolithiasis the location of bile duct stenosis, and the course of important blood vessels. It can provide real-time guidance and assistance for patients with multiple histories of biliary tract surgery.

Key words: complicated hepatolithiasis, laparoscopic ultrasound, bile duct stenosis