切换至 "中华医学电子期刊资源库"

中华普通外科学文献(电子版) ›› 2021, Vol. 15 ›› Issue (01) : 43 -46. doi: 10.3877/cma.j.issn.1674-0793.2021.01.009

所属专题: 文献

论著

腹腔镜超声手术探查对复杂肝内胆管结石患者的临床应用研究
孙宇1, 葛欣1,()   
  1. 1. 150000 哈尔滨,黑龙江省医院普外三科
  • 收稿日期:2020-06-26 出版日期:2021-02-01
  • 通信作者: 葛欣

Clinical application of laparoscopic ultrasonography in patients with complex intrahepatic bile duct stones

Yu Sun1, Xin Ge1,()   

  1. 1. Department of General Surgery, Heilongjiang Provincial Hospital, Harbin 150000, China
  • Received:2020-06-26 Published:2021-02-01
  • Corresponding author: Xin Ge
引用本文:

孙宇, 葛欣. 腹腔镜超声手术探查对复杂肝内胆管结石患者的临床应用研究[J/OL]. 中华普通外科学文献(电子版), 2021, 15(01): 43-46.

Yu Sun, Xin Ge. Clinical application of laparoscopic ultrasonography in patients with complex intrahepatic bile duct stones[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(01): 43-46.

目的

探讨腹腔镜超声手术探查对复杂肝内胆管结石患者的临床应用价值,寻找一种更为安全有效的治疗术式。

方法

回顾性分析黑龙江省医院2017年1月至2019年11月收治的101例复杂肝内胆管结石患者临床资料,患者均进行腹腔镜肝切除术治疗,且术中均实施腹腔镜超声手术探查。分析各项围手术期指标、术后并发症发生情况、中转开腹、入住ICU以及结石复发情况。对比患者手术前后血清丙氨酸氨基转移酶(ALT)、白蛋白(ALB)、天冬氨酸氨基转移酶(AST)、谷氨酰转移酶(GGT)、碱性磷酸酶(ALP)水平。

结果

手术时间为(188.23±54.29)min,术中失血量(210.30±98.74)ml,术后引流时间(3.48±0.91)d,术后住院时间(5.21±1.05)d,结石残留率1.98%(2/101)。患者中转开腹率3.96%(4/101),入住ICU及结石复发人数占比分别为20.79%(21/101)、3.96%(4/101)。术后7例(6.93%)出现并发症,包括2例胆漏,3例术后出血,2例腹腔感染,无肺部感染病例。患者术后血清ALT、AST、GGT、ALP水平明显低于术前,而ALB水平明显高于术前(P<0.05)。

结论

腹腔镜超声手术探查应用于复杂肝内胆管结石患者的效果较佳,可促进患者早日康复,降低术后并发症发生风险,值得临床推广应用。

Objective

To study and analyze the clinical application value of laparoscopic ultrasonography in patients with complex intrahepatic bile duct stones, in order to provide a more safe and effective treatment for this disease.

Methods

The clinical data of 101 patients with complex intrahepatic bile duct stones admitted to Heilongjiang Hospital from January 2017 to November 2019 were retrospectively analyzed. All the patients were treated with laparoscopic hepatectomy, and underwent laparoscopic ultrasonic surgical exploration during the operation. The perioperative indicators, postoperative complications, conversion to laparotomy, admission to ICU and stone recurrence were analyzed. Serum ALT, ALB, AST, GGT and ALP levels of the patients before and after operation were compared.

Results

The operative time was (188.23±54.29) min, the intraoperative blood loss was (210.30±98.74) ml, the postoperative drainage time was (3.48±0.91) d, the postoperative hospital stay was (5.21±1.05) d, and the residual stone rate was 1.98% (2/101). The transfer rate of patients to laparotomy was 3.96% (4/101), and the proportion of patients admitted to ICU and recurrence of stones was 20.79% (21/101) and 3.96% (4/101), respectively. Complications occurred in 7 patients, accounting for 6.93%, including 2 cases of biliary leakage, 3 cases of postoperative hemorrhage, 2 cases of abdominal infection, and no pulmonary infection. Postoperative serum ALT, AST, GGT and ALP level were significantly lower than those before surgery, while ALB level was significantly higher than that before surgery (P<0.05).

Conclusion

The application of laparoscopic ultrasonography in patients with complex intrahepatic bile duct stones can promote the early recovery of patients, reduce the risk of postoperative complications, and is worthy of clinical application.

图1 腹腔镜超声手术探查
图2 腹腔镜超声评估病灶和周围组织的关系
图3 腹腔镜下切除病灶
表1 复杂肝内胆管结石患者手术前后血清肝功能指标水平变化(±s
[1]
Yamamoto R, Abe T, Hosaka S, et al. Intrahepatic bile duct stone treatment combining electrohydraulic lithotripsy and peroral cholangioscopy through a choledochoduodenal fistula[J]. Endoscopy, 2019, 51(10): E290-E292.
[2]
Ogura T, Nishioka N, Higuchi K. Transluminal intrahepatic bile duct stone removal using coaxial basket catheter via the previously created EUS-guided hepaticogastrostomy tract (with videos)[J]. Endosc Ultrasound, 2019, 8(2): 133-135.
[3]
张雯雯,王宏光,陈明易, 等. 腹腔镜超声引导的腹腔镜肝脏切除术[J]. 中华肝胆外科杂志, 2017, 23(11): 762-765.
[4]
李梅生,李清汉,甄作均, 等. Endo-GIA两步法在腹腔镜左半肝切除术中的应用价值[J/CD]. 中华肝脏外科手术学电子杂志, 2017, 6(5): 363-366.
[5]
王晓颖,朱小东. 术中影像引导在腹腔镜和机器人肝切除术中的应用[J]. 中华肝胆外科杂志, 2017, 23(11): 741-744.
[6]
黄长文,李光明,邹书兵, 等. 腹腔镜左半肝切除术治疗肝胆管结石病的临床疗效[J]. 中华消化外科杂志, 2015, 14(2): 152-154.
[7]
Lu H, Yang H, Wu L, et al. A novel prognostic model for diagnosing atypical bile duct hyperplasia in patients with intrahepatic lithiasis[J]. Medicine (Baltimore), 2019, 98(17): e15364.
[8]
Roh YJ, Kim JW, Jeon TJ, et al. Common bile duct stone development due to a Hem-o-lok clip migration: A rare complication of laparoscopic cholecystectomy[J]. BMJ Case Rep, 2019, 12(7): e230178.
[9]
张雯雯,卢实春,陈明易, 等. 腹腔镜超声在胆道外科手术中的应用[J]. 中华肝胆外科杂志, 2019, 25(6): 462-465.
[10]
李成,马跃峰,林美举, 等. 腹腔镜胆囊大部切除术联合胆道镜胆囊颈管探查在复杂胆囊手术中的应用[J]. 中国普通外科杂志, 2020, 29(2): 204-211.
[11]
李锟,张中林,刘权焰, 等. 三维可视化技术联合术中ICG荧光显像在腹腔镜肝癌肝切除术中的应用[J/CD]. 中华肝脏外科手术学电子杂志, 2019, 8(3): 226-229.
[12]
侯冰宗,吕宝军,周少朋, 等. 纤维胆道镜、术中B超、螺旋水刀综合治疗肝内外胆管结石的价值[J/CD]. 中华普通外科学文献(电子版), 2011, 5(1): 25-27.
[13]
李国伟,蔡剑锋,袁年勇, 等. 腹腔镜超声辅助精准肝切除治疗肝内外胆管结石[J]. 中华肝胆外科杂志, 2019, 25(9): 685-688.
[14]
李嘉,徐继威,张彩云, 等. 腹腔镜超声在腹腔镜肝切除术的应用评估[J]. 肝脏, 2018, 23(3): 248-251.
[1] 燕速, 霍博文. 腹腔镜食管胃结合部腺癌根治性切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 13-13.
[2] 母德安, 李凯, 张志远, 张伟. 超微创器械辅助单孔腹腔镜下脾部分切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 14-14.
[3] 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[4] 李子禹, 卢信星, 李双喜, 陕飞. 食管胃结合部腺癌腹腔镜手术重建方式的选择[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 5-8.
[5] 李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12.
[6] 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[7] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[8] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[9] 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[10] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[11] 李华志, 曹广, 刘殿刚, 张雅静. 不同入路下行肝切除术治疗原发性肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 52-55.
[12] 李博, 贾蓬勃, 李栋, 李小庆. ERCP与LCBDE治疗胆总管结石继发急性重症胆管炎的效果[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 60-63.
[13] 王庆亮, 党兮, 师凯, 刘波. 腹腔镜联合胆道子镜经胆囊管胆总管探查取石术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 313-313.
[14] 杨建辉, 段文斌, 马忠志, 卿宇豪. 腹腔镜下脾部分切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 314-314.
[15] 叶劲松, 刘驳强, 柳胜君, 吴浩然. 腹腔镜肝Ⅶ+Ⅷ段背侧段切除[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 315-315.
阅读次数
全文


摘要