无血流阻断腹腔镜解剖性肝切除术治疗肝内胆管结石的临床体会  

Clinical experience of laparoscopic anatomical hepatectomy for hepatolithiasis without blood flow obstruction

作　　者：陈士德[1] 李向国[1] 余再斌[1] 汪晓峰[1] CHEN Shi-de;LI Xiang-guo;YU Zai-bin(Department of General Surgery,the PLA Navy Anqing Hospital,Anqing 246003,China)

机构地区：[1]中国人民解放军海军安庆医院普通外科,安徽安庆246003

出　　处：《腹腔镜外科杂志》2022年第11期839-844,853,共7页Journal of Laparoscopic Surgery

摘　　要：目的:探讨无血流阻断腹腔镜解剖性肝切除术治疗肝内胆管结石的临床疗效及安全性。方法:回顾分析2017年10月1日至2021年5月30日为24例肝内胆管结石患者行无血流阻断腹腔镜解剖性肝切除术的临床资料。结果:1例患者中转开腹,余23例均顺利完成腹腔镜手术。手术时间平均(244.88±71.68)min,中位术中出血量250.00(85,700)mL,术中胆道镜使用时间平均(31.59±9.05)min。肝切除范围包括:Ⅱ、Ⅲ段13例,Ⅱ、Ⅲ、Ⅳ段5例,Ⅴ、Ⅵ、Ⅶ及Ⅷ段2例,Ⅰ、Ⅱ、Ⅲ段1例,Ⅰ、Ⅱ、Ⅲ、Ⅳ段1例,Ⅱ、Ⅲ、Ⅳ_(b)、Ⅵ段1例,Ⅱ、Ⅲ、Ⅶ、Ⅷ段1例。术后肛门排气时间平均(57.50±21.52)h,术后开始进食时间平均(32.00±13.55)h,术后首次下床活动时间平均(41.00±20.61)h,术后引流管拔除时间平均(9.58±4.93)d,术后平均住院(13.21±5.10)d。术后并发症发生率为12.50%,按Clavien分级:Ⅰ级2例(8.33%)、Ⅱ级1例(4.17%),无Ⅲ级以上并发症。24例患者均获得随访,随访7~43个月,中位随访时间27个月。结论:采用无血流阻断腹腔镜解剖性肝切除术治疗肝内胆管结石安全、可行,值得推广应用。Objective:To investigate the clinical efficacy and safety of laparoscopic anatomical hepatectomy without bleeding control for hepatolithiasis.Methods:The clinical data of 24 patients with intrahepatic calculi who received laparoscopic anatomic hepatectomy without blood flow obstruction from Oct.1,2017 to May 30,2021 were retrospectively analyzed.Results:One patient in this group was converted to laparotomy,and the other 23 patients successfully completed laparoscopic surgery.The average operative time was(244.88±71.68)min.The median intraoperative blood loss was 250.00(85,700)mL.Intraoperative choledochoscopic duration was(31.59±9.05)min.The scope of liver resection included:Ⅱ,Ⅲsection in 13 cases;Ⅱ,ⅢandⅣsection in 5 cases;Ⅴ,Ⅵ,ⅦandⅧsection in 2 cases;Ⅰ,ⅡandⅢsection in 1 case;Ⅰ,Ⅱ,ⅢandⅣsection in 1 case;Ⅱ,Ⅲ,Ⅳb andⅥsection in 1 case;Ⅱ,Ⅲ,ⅦandⅧsection in 1 case.The postoperative anal exhaust time was(57.50±21.52)h.Postoperative feeding time was(32.00±13.55)h.The first postoperative ambulation time was(41.00±20.61)h.Postoperative drainage tube removal time was(9.58±4.93)d.The postoperative hospital stay was(13.21±5.10)d.The incidence of postoperative complications was 12.50%.According to the C lavien classification,there were 2 cases(8.33%)in classificationⅠand 1 case(4.17%)in classificationⅡ,and no complications aboveⅢclassification.All 24 patients were followed up for 7-43 months,with a median follow-up of 27 months.Conclusions:Laparoscopic anatomical hepatectomy without occlusion of blood flow is safe and feasible for the treatment of intrahepatic bile duct stones,and worthy to be popularized and applied.

关 键 词：肝内胆管结石 无血流阻断 解剖性肝切除术 腹腔镜检查 

分 类 号：R657.3[医药卫生—外科学]