腹腔镜肝左外叶切除术中经肝断面胆道镜探查取石治疗肝胆管结石的临床研究  

Clinical study of exploration and removal of stones through choledochoscope via hepatic cross-section during laparoscopic left lateral hepatectomy for hepatolithiasis

作　　者：彭沙沙 郭浚[1] 裴斐[1] 方涛 夏国兵[1] 

机构地区：[1]鄂东医疗集团黄石市中心医院(湖北理工学院附属医院)肝胆外科,湖北黄石435000

出　　处：《中国普外基础与临床杂志》2017年第11期1357-1360,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨腹腔镜肝左外叶切除术中经肝断面胆道镜探査取石治疗肝左外叶胆管结石合并胆总管结石的可行性及临床疗效。方法回顾性分析2012年月至2016年12月期间在笔者所在医院科室行手术治疗的肝左外叶胆管结石合并胆总管结石患者的临床资料,其中行腹腔镜肝左外叶切除术中经肝断面胆道镜探查取石术29例(观察组),行腹腔镜肝左外叶切除术中胆总管切开胆道镜探查取石术26例(对照组),比较2组患者的手术时间、术中出血量、术后住院时间、术后营养情况及并发症发生情况。结果2组患者均成功实施手术,均无围手术期死亡病例。2组患者的手术时间及术中出血童比较差异均无统计学意义(P>0.05),观察组的术后住院时间明显短于对照组(P<0.05),2组患者的胆汁漏、膈下感染及胆管结石残余发生率比较差异均无统计学意义(P>0.05),观察组术后第3天和第6天的前体白蛋白及淋巴细胞计数均明显高于对照组(P<0.05)。结论本研究有限的病例研究结果提示,腹腔镜经肝断面胆道镜探査取石治疗肝左外叶胆管结石合并胆总管结石简化手术步骤,避免了胆管切开和T管引流术后相关并发症的发生,安全、可靠。Objective To investigate feasibility and clinical efficacy of exploration and stone removal through choledochoscope via hepatic cross-section during laparoscopic left lateral hepatectomy for hepatolithiasis. Methods The patients who had left extrahepatic bile duct stones with choledocholithiasis from January 2012 to December 2016 were retrospectively collected. Among these patients, 29 cases underwent an exploration and stone removal through choledochoscope via hepatic cross-section during laparoscopic left lateral hepatectomy （observation group） and 26 cases underwent an exploration and stone removal through choledochoscope via incision of common bile duct during laparoscopic left lateral hepatectomy （control group）. The operative time, intraoperative blood loss, postoperative hospital stay, postoperative nutritional, and complications rate were compared between these two groups. Results The operations were performed successfully and no perioperative death happened in both groups. There were no significant differences in the operative time and intraoperative blood loss between the two groups （P〉0.05）. Moreover, the postoperative hospital stay of the observation group was significantly shorter than that of the control group （P〈0.05）. In addition, there were no significant differences in the complications of the bile leakage, subphrenic infection, and biliary residual stones between the two groups （P〉0.05）. Also, the levels of prealbumin and the lymphocytes in the observation group were significantly higher than those in the control group on the 3rd and 6th day after the operation （P〈0.05）. Conclusions Preliminary results of limited cases in this study show that exploration and removal of stones through choledochoscope via hepatic cross-section during laparoscopic left lateral hepatectomy for hepatolithiasis is relatively safe and reliable, its procedure is simplified, could avoid relevant complications due to biliary incision and T tube drainage.

关 键 词：肝胆管结石 肝切除 腹腔镜 胆管探查 

分 类 号：R657.42[医药卫生—外科学]