同期三镜、逐级导管、乳头小切开、T管双导管治疗肝左外叶及胆总管结石15例

The Laparoscopy, Choledochoscopy, Duodenoscopy, Step by Step Dilatable Catheter, the Small Incision of Papillary Sphincterotomy, T Tube + Double Biliary Catheter Bundling and Supporting Drainage for Treatment of the Left Lateral Lobe Hepatic Duct and Common Bile Duct Stones during the Course of Therapeutic Laparoscopy: A Report of 15 Cases

摘要: 目的：探讨同期三镜(腹腔镜、胆管镜、十二指肠镜)逐级扩张导管、乳头小切开、T管双导管(T形管 + 两根裁剪后的鼻胆管导管)捆绑支撑引流(LCTBS)治疗肝左外叶及胆总管结石的临床应用体会。方法：回顾性分析成都市第二人民医院2005年12月至2018年9月期间，符合入选标准的15例患者的临床资料。结果：腹腔镜下切除肝左外叶、胆总管探查胆管镜取石15例，切除胆囊7例。采用逐级导管扩张左肝管和乳头、内镜乳头小切开并留置T形管 + 乳头部双导管支撑引流73.3% (11/15)，逐级导管扩张乳头、内镜乳头小切开并留置T形管 + 乳头部双导管支撑引流20.0% (3/15)，逐级导管扩张左肝管、左肝管整形、肝圆韧带修补缺损并留置T形管 + 左肝内胆管双导管支撑引流6.7% (1/15)。术后左肝内胆管残石1例(6.7%)，胆汁漏1例(6.7%)。无肠穿孔、胆管穿孔、大出血、急性胰腺炎等并发症，无围手术期再次手术和死亡患者。术后总并发症发生率为13.3% (2/15)。结论：对本医院有限病例进行初步研究发现，只要病例选择合适，LCTBS治疗肝左外叶及胆总管结石是可行、有效和安全的。

Abstract: Objective: To explore the surgical technique and clinical effect of laparoscopy, choledochoscopy, duodenoscopy, step by step dilatable catheter, the small incision of papillary sphincterotomy, T tube + double biliary catheter bundling and supporting drainage (LCTBS) 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 15 cases of the left lateral lobe hepatic duct and common bile duct stones undergoing LCTBS were analyzed retrospectively from December 2005 to September 2018 in the Second People’s Hospital of Chengdu. Results: It was in 15 cases removed the left hepatic lateral lobe and exploration of common bile duct, in 7 cases re-moved the gallbladder by laparoscopy. Through step by step dilatable catheter expanded left he-patic duct and duodenal papilla, the small incision of papillary sphincterotomy, indwelling T tube + double biliary catheter drainage of duodenal papilla was in 73.3% (11/15). Through step by step dilatable catheter expanded duodenal papilla, the small incision of papillary sphincterotomy, in-dwelling T tube + double biliary catheter drainage of duodenal papilla was in 20.0% (3/15). Through step by step dilatable catheter expanded left hepatic duct, left hepatic duct plastic surgery, the liver round ligament repairing the defect, indwelling T tube and double biliary catheter drainage of left hepatic duct was in 6.7% (1/15). Residual stone of the left medial lobe hepatic duct occurred in one case (6.7%). Bile leakage occurred in one case (6.7%). No cases had perforation of intestine and bile duct, bleeding, acute pancreatitis. No perioperative reoperation and death. Total postoperative complication formation rate was 13.3% (2/15). Conclusion: From preliminary results of limited cases in our hospital, if patients are suitable, LCTBS for treatment of the left lateral lobe hepatic duct stones and common bile duct stones is safe and effective.