探讨新型腹腔镜下免气腹硬质内镜钬激光碎石治疗肝内胆管结石的疗效。

回顾性分析2023年3月至2023年5月在湖南省人民医院接受腹腔镜下免气腹硬质内镜钬激光碎石手术的6例肝内胆管结石患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男1例，女5例；年龄46～68岁，中位年龄62岁。采用自行研制的新型腹腔镜下硬质内镜钬激光碎石治疗肝内胆管结石，取石过程中无需气腹状态。观察围手术期情况及并发症等。

患者均手术顺利，无中转开腹。患者平均手术时间（145±22）min,术中出血量5～50 ml，中位出血量10 ml。术后住院时间（5.0±0.6）d。围手术期无发生死亡，术中及术后未发生高碳酸血症、气栓、皮下气肿、腹腔感染、胆道出血等并发症，均康复出院。术后第3天复查CT肝内胆管结石无残石。

本中心自行研制的新型腹腔镜下免气腹硬质内镜钬激光碎石治疗肝内胆管结石安全、有效，能有效减少术中气腹相关并发症发生，提高手术效率，缩短手术时间。

To evaluate clinical efficacy of a novel type of laparoscopic pneumoperitoneum-free rigid endoscopic holmium laser lithotripsy in the treatment of hepatolithiasis.

Clinical data of 6 patients with hepatolithiasis who underwent laparoscopic pneumoperitoneum-free rigid endoscopic holmium laser lithotripsy in People's Hospital of Hunan Province from March 2023 to May 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 1 patient was male and 5 female, aged 46-68 years, with a median age of 62 years. A new type of laparoscopic rigid endoscopic holmium laser lithotripsy was self-designed, and pneumoperitoneum was not required intraoperatively. Perioperative conditions and complications were observed.

All patients successfully completed the surgery, and no conversion to open surgery occurred. The average operation time was (145±22) min, and intraoperative blood loss was 5-50 ml, witha median blood loss of 10 ml. The length of postoperative hospital stay was (5.0±0.6) d. No death occurred during perioperative period. No complications, such as hypercapnia, air embolism, subcutaneous emphysema, abdominal infection and biliary bleeding, occurred during and after surgery. All patients were recovered and discharged. CT scan at postoperative 3 d showed no residual hepatolithiasis.

The self-designed novel type of laparoscopic pneumoperitoneum-free rigid endoscopic holmium laser lithotripsy is a safe and efficacious treatment for hepatolithiasis, which can effectively reduce the incidence of intraoperative pneumoperitoneum-related complications, improve surgical efficiency and shorten operation time.