混合入路腹腔镜解剖性左半肝切除术治疗左肝内胆管结石的临床研究  

Clinical study of mixed approach laparoscopic anatomical left hepatectomy for left hepatolithiasis

作　　者：高峰畏 赵欣 谢青云[1,2] GAO Fengwei;ZHAO Xin;XIE Qingyun(Department of Hepatobiliary Pancreatic Surgery,Leshan People’s Hospital of Sichuan,Leshan,Sichuan 614000,P.R.China;Hepatobiliary Pancreatic Splenic Systemic Diseases Center for Diagnosis and Treatment of Leshan City,Leshan,Sichuan 614000,P.R.China)

机构地区：[1]乐山市人民医院肝胆胰腺外科,四川乐山614000 [2]乐山市肝胆胰脾系统性疾病诊疗中心,四川乐山614000

出　　处：《中国普外基础与临床杂志》2021年第2期151-154,共4页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省医学会青年创新课题(项目编号:Q18027)。

摘　　要：目的探讨混合入路腹腔镜解剖性左半肝切除术治疗左肝内胆管结石的安全性及可行性。方法回顾性分析2018年6月至2020年6月期间乐山市人民医院肝胆胰腺外科收治的23例左肝内胆管结石患者的临床资料及随访结果。结果23例患者均在腹腔镜下完成解剖性左半肝切除术。总手术时间的中位数为185 min(153~460 min);断肝手术时间的中位数为110 min(90~125 min);术中总出血量的中位数为175 mL(100~800 mL);断肝出血量的中位数为120 mL(60~560 mL);术中输血2例。术后第1天:AST的中位数为75 U/L(32~437 U/L),ALT的中位数为83 U/L(25~537 U/L),TBIL的中位数为24μmol/L(15.6~42.7μmol/L);术后第3天:AST的中位数为31 U/L(23~129 U/L),ALT的中位数为27 U/L(14~108 U/L),TBIL的中位数为13.5μmol/L(10.4~24.3μmol/L)。术后输血1例,术后住院时间的中位数为7 d(5~20 d),术后拔管时间的中位数为2.5 d(2~5 d),术后发生并发症3例。术后23例患者均获访,随访时间中位数为12个月(6~18个月),随访期间患者无特殊不适,无结石复发、再次手术及死亡病例。结论混合入路腹腔镜解剖性左半肝切除术治疗左肝内胆管结石安全、可行。Objective To explore the safety and feasibility of mixed approach laparoscopic anatomical left hepatectomy for left hepatolithiasis.Method The clinical data and follow-up results of 23 patients with left hepatolithiasis admitted to the Department of Hepatobiliary Pancreatic Surgery in Leshan People’s Hospital from June2018 to June 2020 were retrospectively analyzed.Results All 23 patients underwent anatomical left hepatectomy under laparoscopy.The median of total operation time was 185 min(153–460 min),the median of operation time of liver dissection was 110 min(90–125 min),the median of total blood loss during operation was 175 mL(100–800 mL),the median of blood loss from liver dissection was 120 mL(60–560 mL),blood transfusion was performed in 2 patients during operation.Postoperative day 1:median of AST was 75 U/L(32–437 U/L),median of ALT was 83 U/L(25–537 U/L),median of TBIL was 24μmol/L(15.6–42.7μmol/L);postoperative day 3:median of AST was 31 U/L(23–129 U/L),median of ALT was 27 U/L(14–108 U/L),median of TBIL was 13.5μmol/L(10.4–24.3μmol/L).Postoperative blood transfusion was performed in 1 patient,and the median of postoperative hospital stay was 7 days(5–20 days),median of postoperative extubation time was 2.5 days(2–5 days).Postoperative complications occurred in 3 patients.All 23 patients were followed up after the operation for median of 12 months(6–18 months).During the follow-up period,the patients had no special discomfort,no stone recurrence,reoperation,and death.Conclusion Mixed approach laparoscopic anatomical left hepatectomy is safe and feasible in the treatment of left hepatolithiasis.

关 键 词：肝内胆管结石病 混合入路 腹腔镜左半肝切除术 

分 类 号：R657.3[医药卫生—外科学]