经头背侧入路腹腔镜解剖性左半肝切除术在治疗左肝内胆管结石中的应用  

Analysis of left hepatolithiasis treated with cranial-dorsal approach laparoscopic anatomic left hemihepatectomy

作　　者：柳志[1,2] 沈贤波[1] 周力学[1] 王俊[1] 田秉璋[1] Liu Zhi;Shen Xianbo;Zhou Lixue;Wang Jun;Tian Bingzhang(Department of Hepatobiliary Surgery,Hunan People's Hospital(the First Affiliated Hospital of Hunan Normal University),Changsha 410005,China;Department of Hepatobiliary Surgery,Xingsha Hospital of Hunan People's Hospital(Changsha County People's Hospital),Changsha 410199,China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)肝胆外科,长沙410005 [2]湖南省人民医院星沙院区(长沙县人民医院)肝胆外科,长沙410199

出　　处：《中华肝胆外科杂志》2023年第6期434-437,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨经头背侧入路解剖性左半肝切除术治疗左肝内胆管结石的安全性和可行性。方法回顾性分析2016年10月至2022年6月湖南省人民医院收治的47例行经头侧入路腹腔镜解剖性左半肝切除术的左肝内胆管结石患者的临床资料,其中男性15例,女性32例,年龄(56.45±1.37)岁。分析患者的手术时间、术中失血量、术后肝功能情况及并发症等指标。术后采用电话和门诊方式进行随访。结果47例患者均在腹腔镜下顺利完成手术。中位手术时间260 min,范围160~440 min。中位术中失血量100 ml,范围20~400 ml。术后第1天患者总胆红素为15.7(11.7,21.9)μmol/L,丙氨酸氨基转移酶为126.6(91.7,168.5)U/L,天冬氨酸氨基转移酶为151.1(98.0,212.4)U/L,术后第3天上述指标分别下降为12.6(9.6,16.2)μmol/L、97.9(60.7,156.9)U/L、54.2(40.0,104.1)U/L。术后住院时间的中位数为7 d,范围4~24 d。术后1例患者发生腹腔积液感染,并发症发生率为2.1%(1/47)。本组患者术后复查CT有1例胆总管内结石残留,结石残留率为2.1%(1/47)。术后随访期间无结石复发、死亡等情况发生。结论经头背侧入路解剖性左半肝切除术治疗左肝内胆管结石安全可行。Objective To study the safety and feasibility of anatomic left hemihepatectomy via cranial-dorsal approach in the treatment of left hepatolithiasis.Methods Clinical data of 47 patients with left intrahepatic bile duct stones who underwent cranial-dorsal approach laparoscopic anatomic left hemihepatectomy in Hunan People's Hospital from October 2016 to June 2022 were retrospectively analyzed,including 15 males and 32 females,aged(56.45±1.37)years old.The operative time,intraoperative blood loss,postoperative liver function and complications were analyzed.Patients were followed up by telephone and outpatient review.Results All 47 patients successfully underwent laparoscopic surgery without conversion.The median operative time was 260(range,160-440)min.The median intraoperative blood loss was 100 ml(range,20-400 ml).The total bilirubin,alanine aminotransferase(ALT)and aspartate aminotransferase(AST)levels were 15.7(11.7,21.9)μmol/L,126.6(91.7,168.5)U/L,and 151.1(98.0,212.4)U/L on postoperative day(POD)1,respectively,and decreased to 12.6(9.6,16.2)μmol/L,97.9(60.7,156.9)U/L,54.2(40.0,104.1)U/L on POD 3,respectively.The median postoperative hospital stay was 7(range,4-24)d.Postoperative abdominal effusion and infection occurred in one patient,and the complication rate was 2.1%(1/47).Postoperative CT review found residual stones in common bile duct in one patient[2.1%(1/47)].No stone recurrence or death occurred during postoperative follow-up.Conclusion Anatomic left hemihepatectomy via cranial-dorsal approach is a safe and feasible surgery for the treatment of left hepatolithiasis.

关 键 词：腹腔镜检查 头背侧入路 左半肝切除 肝胆管结石 

分 类 号：R657.3[医药卫生—外科学]