降低肝门板技术在肝内胆管结石行腹腔镜半肝切除中的临床应用  

Clinical application of descending hilar plate technology in laparoscopic heminephrectomy for intrahepatic bile duct calculus

作　　者：孙亭立[1] 淦勤 刘合春[1] SUN Tingli;GAN Qin;LIU Hechun(The First Department of Hepatobiliary Surgery,Jiujiang First People’s Hospital of Jiangxi Province,Jiujiang,Jiangxi 332000,P.R.China)

机构地区：[1]江西省九江市第一人民医院肝胆外一科,江西九江332000

出　　处：《中国普外基础与临床杂志》2020年第6期671-674,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨降低肝门板技术在肝内胆管结石行腹腔镜半肝切除中的临床应用效果。方法回顾性分析2015年1月至2019年12月期间于笔者所在医院接受腹腔镜半肝切除术治疗的肝内胆管结石患者40例,根据手术方式的不同分组,将接受Pringle全肝入肝血流阻断技术的21例患者归为对照组,将接受腹腔镜下降低肝门板技术半肝切除的19例患者归为观察组,比较2组患者的手术时间、术中出血量、术后住院时间、肝功能恢复及术后并发症发生情况。结果2组患者的术中出血量和手术时间比较差异均无统计学意义(P>0.05),但观察组的术后住院时间缩短(P=0.025)。2组患者手术前后的ALT、TB和AST水平的差值比较差异有统计学意义(P<0.05),观察组降低更明显。2组的总并发症发生率比较差异无统计学意义(P=0.128)。结论与Pringle全肝入肝血流阻断技术比较,降低肝门板技术在腹腔镜半肝切除中,利于充分显露左肝、右肝Glisson蒂,便于实施半肝血流阻断,对健侧肝脏损伤较小,肝功能恢复较快,缩短了术后住院时间。Objective To investigate the clinical application effect of descending hilar plate technology in laparoscopic heminephrectomy for intrahepatic bile duct calculus.Methods The clinical data of 40 patients with intrahepatic bile duct calculus who underwent laparoscopic heminephrectomy in our hospital from January 2015 to December 2019 were retrospectively analyzed.The patients were grouped according to different surgical procedures,21 patients with Pringle method of total hepatic vascular exclusion were classified in the control group,and 19 patients with descending hilar plate technology of blood occlusion technology were classified in the observation group.The operation time,intraoperative bleeding volume,postoperative hospital stays,liver function recovery,and postoperative complications were compared between the two groups.Results There was no statistically significant difference between the two groups in the intraoperative bleeding volume and operation time(P>0.05),but the postoperative hospital stays in the observation group shortened(P=0.025).The changes on the ALT,TB,and AST in the observation group was obvious than those of the control group(P<0.05).There was no statistically significant incidence between the two groups in the total incidence of complications(P=0.128).Conclusions Compared with Pringle method of total hepatic vascular exclusion,descending hilar plate technology in laparoscopic heminephrectomy can fully expose the Glisson pedicles of the left and right livers,and it is convenient to implement hemihepatic blood flow occlusion.It has less damage to healthy side of the liver and quicker liver function recovery,and it can reduce postoperative complications and shorten postoperative hospital stay.

关 键 词：肝内胆管结石 腹腔镜半肝切除术 降低肝门板技术 PRINGLE法 肝血流阻断技术 手术指标 肝功能恢复 并发症 

分 类 号：R657.3[医药卫生—外科学]