同期三镜、扩张导管、气囊鼻胆管治疗肝左外叶及胆总管结石26例

Abstract

目的：探讨同期三镜(腹腔镜、胆管镜、十二指肠镜)、扩张导管(逐级扩张导管、球囊导管)、气囊鼻胆管(LCDND)治疗肝左外叶及胆总管结石的应用体会。方法：回顾性分析成都市第二人民医院2011年3月至2017年9月期间，符合入选标准的26例患者的临床资料。结果：腹腔镜下切除肝左外叶和探查胆总管胆管镜取石26例，切除胆囊15例。逐级导管扩张左肝管和乳头并留置气囊鼻胆管65.5% (17/26)，逐级导管扩张左肝管和推挤左肝管结石出总管切口并留置气囊鼻胆管11.5% (3/26)，逐级导管联合球囊导管扩张左肝管并留置气囊鼻胆管3.8% (1/26)，逐级导管扩张左肝管和乳头、十二指肠镜行乳头小切开或微切开并留置气囊鼻胆管11.5% (3/26)，逐级导管扩张左肝管后因肝内胆管残石并腹腔镜下留置T管7.7% (2/26)。鼻胆管引流术后无残石，胆汁漏2例(7.7%)，轻症胰腺炎1例(3.8%)。无肠穿孔、胆管穿孔、大出血、重症胰腺炎等并发症，无围手术期再次手术和死亡患者。术后总并发症发生率为11.5% (3/26)。结论：从本研究对本医院有限病例进行初步研究发现，只要病例选择合适，LCDND治疗肝左外叶及胆总管结石是可行、有效和安全的。 Objective: To explore the surgical technique and clinical effect of laparoscopy, choledochoscopy, duodenoscopy, dilatable catheter and balloon nasobiliary drainage (LCDND) of the corresponding period for the treatment of the left lateral lobe hepatic duct and common bile duct stones during the course of therapeutic laparoscopy. Methods: The clinical data of 26 cases of the left lateral lobe hepatic duct and common bile duct stones undergoing LCDND were analyzed retrospectively from March 2011 to September 2017 in the Second People’s Hospital of Chengdu. Results: It was in 26 cases removed the left hepatic lateral lobe and exploration of common bile duct and in 15 cases removed the gallbladder by laparoscopy. Through the duct incision with choledochoscopy to remove gallstones, step by step dilatable catheter expanded left hepatic duct and duodenal papilla and indwelling balloon nasobiliary was in 65.5% (17/26); push the stones into the common hepatic duct in 11.5% (3/26); step by step dilatable catheter combining balloon catheter expanded left hepatic duct and duodenal papilla and indwelling balloon nasobiliary was in and 3.8% (1/26); step by step dilatable catheter expanded left hepatic duct and duodenal papilla and duodenoscopic papillary sphincterotomy of micro incision or small incision, and indwelling balloon nasobiliary was in 11.5% (3/26); via choledochoscopic examination indwelling T shape tube drainage due to residual stone of the intrahepatic bile duct in 7.7% (2/26). Residual stone was not occurred after the nasobiliary drainage. Bile leakage was cured in two cases (7.7%). One patient (3.8%) was a slight pancreatitis. No cases had perforation of intestine and bile duct, bleeding, severe pancreatitis. No perioperative reoperation and death. Total postoperative complication formation rate was in 11.5% (3/26). Conclusion: From preliminary results of limited cases in this study in our hospital, if patients are suitable, LCDND for treatment of the left lateral lobe hepatic duct stones and common bile duct stones, it is safe and effective.