保留左肝管主干的前入路左半肝切除术在预防胆漏中的应用  

Application of approach of anterior left hemihepatectomy combined with preservation of the main trunk of left hepatic duct in the prevention of bile leakage

作　　者：陈曦[1] 叶青 袁寅[2] 杨兴业[2] 周红兵[2] 刘庆宏[2] 钱海鑫[1] 

机构地区：[1]苏州大学附属第一医院普通外科,江苏苏州215006 [2]泰州市人民医院肝胆外科,江苏泰州225300

出　　处：《肝胆胰外科杂志》2017年第6期457-460,共4页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨保留左肝管主干的前入路左半肝切除术在治疗左肝内胆管结石预防胆漏中的应用价值。方法回顾性分析泰州市人民医院2008年1月至2016年9月行左半肝切除术治疗的左肝内胆管结石患者75例,其中行保留左肝管主干的前入路左半肝切除术37例(前入路组),传统入路左半肝切除术38例(传统组),比较两组手术时间、术中失血量、住院天数及术后胆漏并发症的差异。结果所有病例均顺利完成手术。两组的性别、年龄、肝功能Child-Pugh分级的比较无统计学差异,前入路组较传统组手术时间短[(153.27±19.55)min vs(184.26±22.41)min,t=-6.38,P<0.01],术中出血量少[(109.78±18.41)m L vs(317.71±28.14)m L,t=-37.76,P<0.01],住院时间短[(10.16±0.65)d vs(15.39±1.03)d,t=-26.32,P<0.01],术后胆漏并发症例数少(1 vs 13,χ~2=12.26,P<0.01)。结论保留左肝管主干的前入路左半肝切除术可减少手术时间、术中失血量和住院时间,并显著减少术后胆漏发生率,在左半肝切除治疗左肝内胆管结石中值得推广。Objective To evaluate the application value of approach of anterior left hemihepatectomy combinedwith preservation of the main trunk of left hepatic duct in the prevention of bile leakage. Methods A totalof 75 patients with left hepatolithiasis who underwent left hemihepatectomy between Jan. 2008 and Sep. 2016 inTaizhou People’s Hospital were retrospectively analyzed. Among them, 37 patients underwent anterior approachof left hemihepatectomy combined with preservation of the main trunk of left hepatic duct （anterior approachgroup）, and 38 patients underwent left hemihepatectomy via traditional approach （traditional approach group）. Thedifferences in operation duration, intraoperative blood loss, hospitalization duration and postoperative bile leakagewere compared between two groups. Results All patients underwent surgeries successfully. There were nostatistically significant differences in sex, age and grade of Child-Pugh liver function between the two groups, thepatients in the anterior approach group had shorter operation duration [（153.27±19.55）min vs （184.26±22.41）min,t=-6.38, P〈0.01], less intraoperative blood loss [（109.78±18.41）mL vs （317.71±28.14）mL, t=-37.76, P〈0.01],shorter hospitalization duration [（10.16±0.65）d vs （15.39±1.03）d, t=-26.32, P〈0.01] and fewer cases with postoperativebile leakage （1 vs 13, χ2=12.26, P〈0.01）. Conclusion The approach of anterior left hemihepatectomycombined with preservation of the main trunk of left hepatic duct can reduce the operation duration, intraoperativeblood loss and hospitalization duration, and significantly reduces the incidence of postoperative bile leakage,thus it is the preferred method for left hepatectomy treatment of hepatolithiasis and is of worthy of promotion.

关 键 词：左半肝切除术 胆漏 左肝管 前入路 肝胆管结石病 

分 类 号：R657.42[医药卫生—外科学]