Analysis of Laparoscope-Ureteroscope Combination for Lithotripsy in 36 Patients with Hepatolithus_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHONG Xianrong ¹ , TAN Zhijun ² , KONG Yong ¹ , WANG Zulai ¹ , CHEN Zehua ¹ , CHEN Kun ¹

1.Department of General Surgery, Guidong People’s Hospital of Guangxi, Wuzhou 543001, Guangxi, China;;
2.Department of General Surgery, The First Center Hospital of Tianjin City, Tianjin 300192, ChinaCorresponding Author: ZHONG Xian-rong， E-mail： maoyu200520197@163.com;

Corresponding author：

Keywords：

Laparoscope; Ureteroscope; Hepatolithus; Minimal invasion; Surgery

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　　Objective 　To evaluate the clinical value of ureteroscope in cholelithiasis treated by laparoscopic surgery.
　　Methods 　The clinical data of 36 patients admitted because of hepatolithus with ureteroscope combination in laparoscopic surgery from February 2007 to September 2009 in Guidong People’s Hospital of Guangxi were analyzed retrospectively.
　　Results 　In 33 cases, stones were removed once by ureteroscope in laparoscopic surgery with residual stones (in 3 cases residual stone were removed secondarily through T tube) and the other 3 cases were transferred to laparotomy forcedly due to bleeding of biliary duct and vessels of porta hepatis and tearing of bile duct. During operation, blood loss was 30-280 (94.51±54.70) ml; operation time was 110-260 (147.22±48.45) min; recovery time of bowel movement was 1-3 (2.03±0.76) d; postoperative hospitalization time was 6-13 (7.12±1.65) d (some discharged with T tube); the time of patients of T tubes pulled out was 28-45 (38.92±6.52) d. Bile leakage happened in 1 case and infection of biliary tract in 1 case, no complications such as biliary stricture or bile duct bleeding were found after operation.
　　Conclusions 　Treatment of intrahepatic bile duct or a single extra-hepatic sand-like stones with ureteroscopy usage in laparoscopic surgery is feasible and less invasive. It is a minimally invasive treatment for intra- or extra-hepatic stones due to rapidly postoperative rehabilitation.

Citation： ZHONG Xianrong,TAN Zhijun,KONG Yong,WANG Zulai,CHEN Zehua,CHEN Kun. Analysis of Laparoscope-Ureteroscope Combination for Lithotripsy in 36 Patients with Hepatolithus. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(4): 379-382. doi: Copy

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11.	Khan MR, Naureen S, Hussain D, et al. Management outcome of residual common bile duct stones at Aga Khan University Hospital [Ｊ]. J Ayub Med Coll Abbottabad, 2005; 17(3): 7-10.
12.	刘崇忠, 胡三元, 王磊, 等. 腹腔镜胆总管探查术587 例临床分析 [Ｊ]. 中华外科杂志, 2007； 45(3): 189-191.
13.	Bark K, Gamblin TC, Zuckerman R, et al. Operative choledochoscopic laser lithotripsy for impacted intrahepatic gallstones: a novel surgical approach [Ｊ]. Surg Endosc, 2008； 6(5): 238-242.
14.	胡三元. 肝内、外胆管结石的腹腔镜处理 [Ｊ]. 中国普外基础与临床杂志, 2008; 16(10): 711-713.
15.	郑民华, 张卓. 腹腔镜胆道探查的技术要点 [Ｊ]. 肝胆外科杂志, 2008; 16(3): 165-166.
16.	侯东生, 刘衍民. 电视输尿管硬镜治疗胆道结石 [Ｊ]. 中国内镜杂志, 1997; 3(4): 47-48.
17.	张庄文, 付星, 李元健. 腹腔镜手术与开腹手术行胆总管切开取石的对比研究 [Ｊ]. 中国普通外科杂志, 2008; 17(2): 117-119.
18.	韩文秀. 胆管结石微创外科治疗进展 [Ｊ]. 中华消化内镜杂志, 2009; 26(9): 502-504.
19.	Tai CK, Tang CN, Ha JP, et al. Laparoscopic exploration of common bile duct in difficult choledocholithiasis [Ｊ]. Surg Endosc, 2004; 18(6): 910-914.
20.	周其林, 梁久银, 侯辉, 等. 腹腔镜胆总管探查并发症分析 [Ｊ]. 中国微创外科杂志， 2008; 8（5）： 393-394.
21.	钟兴国, 熊茂明, 孟翔凌, 等. 腹腔镜胆管探查术常见并发症原因及防治对策 [Ｊ]. 中国临床医学, 2008; 15(5): 636-637.

1. Yoon YS, Han HS, Shin SH, et al. Laparoscopic treatment for intrahepatic duct stones in the era of laparoscopy: laparoscopic intrahepatic duct exploration and laparoscopic hepatectomy [Ｊ]. Ann Surg, 2009; 249(2): 286-291.
2. 　周荣军, 徐绍忠, 陈爱军, 等. 腹腔镜联合输尿管镜肝内外胆管取石术（附34例报告） [Ｊ]. 中国现代手术学杂志, 2008; 12(5): 335-336.
3. 　Machado MA, Makdissi FF, Surjan RC, et al. Laparoscopic right hemihepatectomy for hepatolithiasis [Ｊ]. Surg Endosc, 2007; 21(11): 302-308.
4. 　张涛，凌亚菲，郭建平. 腹腔镜配合胆道镜治疗肝内胆管结石 [Ｊ]. 中国内镜杂志， 2008; 14（3）： 290-294.
5. 　陈积圣. 肝胆管结石的微创治疗的进展 [Ｊ]. 中国微创外科杂志, 2007; 7(2): 93-94.
6. 　洪德飞，彭淑牖. 腹腔镜肝胆胰脾外科手术操作与技巧 [M]. 北京: 人民卫生出版社， 2008： 74-75.
7. 　陶涛, 石刚, 彭祥玉, 等. 腹腔镜和胆道镜联合治疗胆总管结石(附523例报道) [Ｊ]. 中国普外基础与临床杂志, 2009; 16(8): 649-653.
8. 　段伦喜, 钟德玝, 苗雄鹰, 等. 肝切除联合纤维胆道镜治疗肝胆管结石临床分析 [Ｊ]. 中华普通外科杂志, 2006; 21(3): 164-166.
9. 　Hazey JW, McCreary M, Guy G, et al. Efficacy of percutaneous treatment of biliary tract calculi using the holmium: YAG laser [Ｊ]. Surg Endosc, 2007； 21(7): 1180-1183.
10. 　陈佐会, 罗平. 内镜、腹腔镜联合治疗胆囊结石合并胆总管结石（附51例报告） [Ｊ]. 中国普外基础与临床杂志, 2005； 12(6): 569-570.
11. 　Khan MR, Naureen S, Hussain D, et al. Management outcome of residual common bile duct stones at Aga Khan University Hospital [Ｊ]. J Ayub Med Coll Abbottabad, 2005; 17(3): 7-10.
12. 　刘崇忠, 胡三元, 王磊, 等. 腹腔镜胆总管探查术587 例临床分析 [Ｊ]. 中华外科杂志, 2007； 45(3): 189-191.
13. 　Bark K, Gamblin TC, Zuckerman R, et al. Operative choledochoscopic laser lithotripsy for impacted intrahepatic gallstones: a novel surgical approach [Ｊ]. Surg Endosc, 2008； 6(5): 238-242.
14. 　胡三元. 肝内、外胆管结石的腹腔镜处理 [Ｊ]. 中国普外基础与临床杂志, 2008; 16(10): 711-713.
15. 　郑民华, 张卓. 腹腔镜胆道探查的技术要点 [Ｊ]. 肝胆外科杂志, 2008; 16(3): 165-166.
16. 　侯东生, 刘衍民. 电视输尿管硬镜治疗胆道结石 [Ｊ]. 中国内镜杂志, 1997; 3(4): 47-48.
17. 　张庄文, 付星, 李元健. 腹腔镜手术与开腹手术行胆总管切开取石的对比研究 [Ｊ]. 中国普通外科杂志, 2008; 17(2): 117-119.
18. 　韩文秀. 胆管结石微创外科治疗进展 [Ｊ]. 中华消化内镜杂志, 2009; 26(9): 502-504.
19. 　Tai CK, Tang CN, Ha JP, et al. Laparoscopic exploration of common bile duct in difficult choledocholithiasis [Ｊ]. Surg Endosc, 2004; 18(6): 910-914.
20. 　周其林, 梁久银, 侯辉, 等. 腹腔镜胆总管探查并发症分析 [Ｊ]. 中国微创外科杂志， 2008; 8（5）： 393-394.
21. 　钟兴国, 熊茂明, 孟翔凌, 等. 腹腔镜胆管探查术常见并发症原因及防治对策 [Ｊ]. 中国临床医学, 2008; 15(5): 636-637.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of Laparoscope-Ureteroscope Combination for Lithotripsy in 36 Patients with Hepatolithus

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