腹腔镜肝切除术治疗复发性肝胆管结石  

Laparoscopic hepatectomy in the treatment of recurrent hepatolithiasis

作　　者：李伟男[1] 李强[1] 徐建[1] 杨刚[1] 李勇[1] 刘健[1] 李敬东[1] Li Weinan;Li Qiang;Xu Jian;Yang Gang;Li Yong;Liu Jian;Li Jingdong(Department of Hepatobiliary Surgery, Affiliated Hospital of Chuanbei Medical College, Nanchong 637000, Chin)

机构地区：[1]川北医学院附属医院肝胆外科川北医学院肝胆胰肠疾病研究所,四川省南充637000

出　　处：《中华普通外科杂志》2018年第4期309-313,共5页Chinese Journal of General Surgery

摘　　要：目的评估腹腔镜肝切除术治疗复发性肝胆管结石的安全性和有效性。方法分析复发性肝胆管结石行腹腔镜肝切除术患者的临床资料。结果17例复发性肝胆管结石患者中，5例行单纯肝叶（肝段）切除术，12例行胆管切开取石＋肝叶（肝段）切除。手术时间（236±86）min，术中出血量（430±101）ml。术后患者胃肠道恢复时间（2．5±0．9）d，术后住院时间（12．3±3．9）d；术后并发症：膈下积液3例，肝断面感染2例，切口感染1例，术后残石2例，胆漏2例，肺部感染2例，胸腔积液3例，均通过非手术治疗治愈。15例获得随访，随访时间为2～24个月。结论腹腔镜肝切除术在复发性肝胆管结石中的应用是安全有效的。Objective To explore the safety and effectiveness of laparoseopic hepatectomy in the treatment of recurrent hepatolithiasis. Methods The clinical data of recurrent hepatolithiasis patients treated by laparoscopic hepatectomy were studied. Results Among the 17 patients of recurrent hepatolithiasis patients, 5 received hepatic segmentectomy （lobectomy）, 12 cases received hepatic segmentectomy （ lobeetomy ） , exploration of the comnon bile duct and T-tube drainage, 1 case received hepatic segmenteetomy （lobeetomy） plus exploration of the common bile duct. The mean operation time and operative blood loss were （ 236 ± 86 ） rain and （ 430 ± 101 ） ml, respectively. The time of gastrointestinal function recovery and postoperative hospital stay were （2. 5 ±0. 9） d and （12. 3 ± 3.9） d. Postoperative complications included postoperative sub-phrenic hydrops in 3 cases, liver margin infection in 2 cases, incision infection in 1 case, residual stone in 2 cases, bile leak in 2 cases, the pulmonary infection in 2 cases pleural effusion in 3 cases. All were cured by non-surgical treatment. Postoperatively 15 were followed up for 2 - 24 months. Conclusions It is safe and feasible for laparoscopic hepatectomy to treat recurrent hepatolithiasis.

关 键 词：胆石 肝切除术 胆管 肝内 腹腔镜 

分 类 号：R657.4[医药卫生—外科学]