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肝胆管结石病在我国部分地区发病率仍较高,虽然开展腹腔镜治疗肝胆管结石病单位逐年增多,但不同地区技术水平差别较大,在患者筛选和技术方法等方面尚未形成系统化、规范化的方案.为此,中国医师协会外科医师分会微创外科医师专业委员会组织国内相关领域的知名专家,就腹腔镜治疗肝胆管结石病的相关临床问题进行了充分研讨,形成了以下共识:肝胆管结石病的腹腔镜治疗原则仍是黄志强院士倡导的“去除病灶,解除梗阻,矫正狭窄,通畅引流”16字方针.手术适应证为Ⅰ型和部分Ⅱa型肝胆管结石病.手术方式包括腹腔镜肝切除术、腹腔镜胆管切开+胆道镜探查和(或)取石术以及腹腔镜胆管整形和(或)胆肠吻合术,多数肝胆管结石病患者需要实施以腹腔镜肝切除术为主导的联合手术方式.腹腔镜肝切除术是肝胆管结石病的基本外科治疗手段,要求以肝段、肝叶为单位行解剖性切除,这是取得优良疗效、减少结石残留和复发的基本条件和关键；腹腔镜胆管切开+胆道镜探查和(或)取石术可最大限度避免结石遗漏、术后胆道狭窄及梗阻,亦可单独作为少数肝胆管结石病患者的定型手术方式；腹腔镜胆管整形和(或)胆肠吻合术属临床探索性微创技术,实践者应具备丰富的胆道外科经验及娴熟的腹腔镜外科技术和(或)达芬奇机器人手术系统操作技术.本专家共识特别强调腹腔镜超声及解剖性肝切除术在腹腔镜治疗肝胆管结石病中的重要作用；计划性中转开腹为术中转换手术方式,是目前微创术式最常见策略,不能视为腹腔镜手术失败或并发症.腹腔镜治疗肝胆管结石病的疗效评估,应涵盖术后动态影像学(超声、CT、MRI或MRCP、T管造影)、胆道镜、肝脏功能等检查,以及患者术后症状改善、生命质量评分等随访内容.

The incidence of hepatolithiasis in some regions of China is still high.Although laparoscopic treatment of hepatolithiasis is increasingly carried out in medical centers year by year,the technical level between regions varies,and systematic and standardized programs have not been formed in terms of case selection and technical methods.So a consensus is made according to the results of full discussion of known experts in the related fields.The principle of laparoscopic treatment of hepatolithiasis was advocated by academician HUANG Zhi-qiang,and it includes "removal of lesions,relief of obstruction,alleviation of stricture and retaining of the drainage of bile duct".The surgical indications of laparoscopic treatment of hepatolithiasis include type Ⅰ and a part of type Ⅱ hepatolithiasis.The surgical procedures include laparoscopic hepatectomy,laparoscopic bile duct incision + choledochoscopic exploration and (or) lithotomy and laparoscopic bilioplasty and (or) bilioenteric anastomosis.Most of the hepatolithiasis patients need to undergo joint surgery which is dominated by laparoscopic hepatectomy.Laparoscopic hepatectomy is the basic surgical procedure for the treatment of hepatolithiasis,and anatomical resection is the key point for achieving excellent efficacy and reducing residual stones and recurrence.Laparoscopic bile duct incision + choledochoscopic exploration and (or) lithotomy can avoid the stones missing,biliary stricture and obstruction to the greatest extent,and it can also be used alone as a definitive surgery for few hepatolithiasis patients;the efficacy of laparoscopic bilioplasty and (or) bilioenteric anastomosis is still under research,which could be carried out by skilled laparoscopic biliary surgery experts or surgeons with the assistance of da Vinci surgical robotic system.The effects of laparoscopic ultrasound and anatomical hepatectomy are specially emphasized in laparoscopic treatment of the hepatolithiasis;planned conversion to open surgery should not be regarded as a failure or complications of laparoscopic surgery,but a shift of surgical procedure.The efficacy of laparoscopic treatment of hepatolithiasis should be evaluated according to the results of imaging examinations (B-ultrasound,computed tomography,magnetic resonance imaging/magnetic resonance cholangiopancreatography,T tube cholangiography),choledocoscopic exploration,hepatic function test as well as recovery of the condition of patients and rating of quality of life.