循肝中静脉腹腔镜解剖性左半肝切除术治疗左肝内胆管结石临床研究  

Clinical study of laparoscopic anatomical left-hepatectomy guided by the middle hepatic vein in the treatment of hepatolithiasis

作　　者：黄龙[1] 王丹凤 黄文涛[1] 邱福南[1] 严茂林[1] 周松强[1] 赖智德[1] 王耀东[1] 田毅峰[1] 郑晓春[1] 陈实[1] HUANG Long;WANG Dan-feng;HUANG Wen-tao;CHEN Shi(Department of Hepatobiliopancreatic Surgery,Fujian Provincial Hospital,Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院肝胆胰外科,福建福州350001

出　　处：《中国实用外科杂志》2020年第7期808-812,共5页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金(No.81772560);福建省自然科学基金杰出青年项目(No.2018J06020)。

摘　　要：目的探讨腹腔镜循肝中静脉(MHV)入路解剖性左半肝切除术治疗左肝内胆管结石的安全性及有效性。方法回顾性分析2016年1月至2019年10月福建省立医院肝胆胰外科行腹腔镜左半肝切除术的130例左肝内胆管结石病人的临床资料,按2∶1比例进行倾向性评分匹配后,筛选出行未循MHV的腹腔镜解剖性左半肝切除术72例(未循MHV组),行循MHV入路腹腔镜解剖性左半肝切除术36例(循MHV组),比较两组手术安全性及近远期疗效。结果与未循MHV组比较,循MHV组手术时间延长(P<0.05),结石清除率增高(P<0.05),而在腹腔出血、腹腔脓肿、肺部感染、肝功能衰竭、感染性休克、再次手术、术后死亡等术后并发症发生率及住院时间方面差异无统计学意义(P>0.05)。随访6~48个月,未循MHV组与循MHV组病人在结石残留率(18.1%vs.2.8%)、结石复发率(19.4%vs.2.8%)、胆管炎复发率(18.1%vs.2.8%)方面差异均有统计学意义(χ^2=4.965、5.574、4.965,P均<0.05)。结论循MHV入路腹腔镜解剖性肝切除术治疗左肝内胆管结石安全有效,可提高结石取尽率,降低胆瘘发生率及结石复发率。Objective To investigate the safety and effectiveness of laparoscopic anatomical left-hepatectomy guided by the middle hepatic vein in the treatment of hepatolithiasis.Methods The clinical data of 130 patients who underwent laparoscopic left hemihepatectomy from January 2016 to October 2019 in Department of Hepatobiliopancreatic Surgery,Fujian Provincial Hospital,Fujian Medical University were analyzed retrospectively.They were divided into the group of anatomical hepatectomy guided by the middle hepatic vein and the group of traditional hepatectomy.After matching,72 patients under went traditional laparoscopic left hepatectomy,36 patients underwent anatomical left hepatectomy guided by the middle hepatic vein.The safety and effects of the two groups were compared.Results Compared to the group of traditional laparoscopic left hepatectomy,the operation time of the group of anatomical hepatectomy guided by the middle hepatic vein was longer(P<0.05),the rate of stone clearance was higher(P<0.05).However,there was no significant difference in the incidence of postoperative complications and hospitalization time in intraperitoneal hemorrhage,abdominal abscess,pulmonary infection,liver failure,septic shock,reoperation,postoperative death and hospital stay(P>0.05).Followed for 6 to 48 months,there were significant differences betWeen the group of traditional laparoscopic left hepatectomy and the group of anatomical hepatectomy guided by the middle hepatic vein(χ^2=4.965,5.574,4.965;all P<0.05)in stone residual rate(18.1%vs.2.8%),stone recurrence rate(19.4%vs.2.8%)and cholangitis recurrence rate(18.1%vs.2.8%).Conclusion Laparoscopic anatomical hepatectomy guided by the middle hepatic vein is safe and effective in the treatment of left hepatolithiasis,which can improve the rate of stone removal,reduce the rate of bile leakage and stone recurrence.

关 键 词：肝内胆管结石 腹腔镜 肝中静脉 解剖性肝切除术 

分 类 号：R6[医药卫生—外科学]