肝内结石,或者肝胆管结石,是东南亚的一种地方病,虽然,随着来自东方国家的移民,这种病理的发病率在世界范围内呈上升趋势。拉丁美洲的经验表明,发病率和死亡率与其他西方国家一致,但是缺乏微创手术。我们展示了一种联合手术和内窥镜清除结石的方法。我们介绍了一例47岁的女性患者进行胆肠吻合术,以治疗因肝内结石引起的复发性化脓性胆管炎。病人被送进急诊室,出现了新的胆管炎发作,并接受经皮肝胆引流。多学科方法,包括内窥镜和手术团队,通过激光碎石术和开放式取石成功清除结石。术后期间平安无事,一年后患者未出现任何复发迹象。在这种新颖的情况下,手术和内窥镜联合方法取得了短期的临床和技术成功。此外,个性化需要开放手术通道的病例是可行的,这允许结合内窥镜方法与安全。
Intrahepatic lithiasis, or hepatolithiasis, is an endemic disease in southeast Asia, although, with immigration from Eastern countries, the incidence of this pathology is rising worldwide. The Latin American experience demonstrates morbidity and mortality compatible with other Western countries, but minimally invasive procedures are lacking. We demonstrate a
case of a combined surgical and endoscopic approach for stone clearance. We present a
case of a 47-year-old female patient with biliary enteric anastomosis to treat recurrent pyogenic cholangitis resulting from intrahepatic lithiasis. The patient was admitted to the emergency room, presented with a new episode of cholangitis, and submitted to transcutaneous hepatobiliary drainage. The multidisciplinary approach, including the endoscopic and surgical teams, successfully performed the stone clearance with laser lithotripsy and stone removal by open access. The postoperative period was uneventful, and the patient did not present any sign of recurrence after one year. A combined surgical and endoscopic approach achieved short-term clinical and technical success in this novel
case. Moreover, individualizing cases requiring open surgical access is feasible, which allows a combined endoscopic approach with safety.