关键词: 胆管,肝内, 结石, 胆道外科手术, 腹腔镜

Abstract:

To investigate the effect and feasibility of total laparoscopy to treat hepatolithiasis using gallbladder-hepatic duct subcutaneous tunnel．Retrospective analysis was conducted of the case data of 11 patients with hepatolithiasis who underwent total laparoscopic treatment using gallbladder-hepatic duct subcutaneous tunnel from January 2010 to October 2014. The operation time, blood loss, postoperative complications and recurrence of stones were recorded．All the cases completed the operation．The average hospital-stay was 9.2 days (range: 3－29 d). The average operation time was 298 min (range: 225－480 min). The average blood loss was 253 mL (range: 50－700 mL), and the average blood loss of liver resection groups was 325 mL (range: 200－700 mL). The average discharge time was 3.3 days (range: 3-5 d). The rate of postoperative residual stones was 36.4% (4/11).We extracted stones with choledochofiberscope via T-tube sinus six weeks after operation. One case developed biliary leakage, and healed through adequate drainage and the T-tube was pulled out after one month. There was no perioperative mortality. All the cases were followed up and the mean follow-up was 22 months (range： 2－51 months). The anastomotic stenosis of gallbladder-hepatic duct was found in one case. But we got a good therapeutic result with performed gallbladder chemical ablation with 95% ethanol. No recurrence of hepatolithiasis was found. As a choice for minimally invasive method to hepatolithiasis using gallbladder-hepatic duct subcutaneous tunnel，total laparoscopy is a safe and feasible procedure.

Key words: Bileducts, intrahepatic, Calculi, Biliary tract surgical procedures, Laparoscopy