完全腹腔镜下左肝蒂阻断行左半肝切除术治疗肝内外胆管结石
| 作者: |
1陈洋,
1司亚卿,
1王钊,
1王群,
1王佳辰,
1袁甲翔,
1厉荣康
1 郑州大学第一附属医院 腹腔镜外科，河南 郑州 450052 |
| 通讯: |
司亚卿
Email: siyaqing2008@163.com |
| DOI: | 10.3978/.10.3978/j.issn.1005-6947.2016.08.001 |
摘要
目的：探讨应用左肝蒂阻断法行完全腹腔镜左半肝切除术治疗肝内外胆管结石的可行性、安全性和有效性。方法：回顾性分析2010年月9月—2015年12月间行手术治疗（左半肝切除术、胆囊切除术、胆总管切开探查、胆道镜探查取石、T管引流）的32例肝内外胆管结石患者资料，其中18例患者应用左肝蒂阻断法行完全腹腔镜下手术（腹腔镜组），14例患者采用传统开腹手术（开腹组）。比较两组患者的相关临床指标。结果：两组患者术前资料具有可比性。所有患者均顺利完成手术，腹腔镜组无中转开腹手术。与开腹组比较，腹腔镜组的手术时间延长（273.0 min vs. 214.0 min，P<0.05），手术费用增加（5 550.0元 vs. 3 962.0元，P<0.05），但术后丙氨酸转氨酶水平（术后1 d：158.2 U/L vs. 291.5 U/L；术后7 d：33.3 U/L vs. 52.2 U/L）、疼痛缓解时间（3.2 h vs. 5.0 h）、术后排气时间（23.3 h vs. 45.5 h）、术后住院时间（12.0 d vs. 15.7 d）方面均有明显优势（均P<0.05）；两组术中出血量（226.7 mL vs. 189.3 mL）、住院总费用
（41 304.4元vs. 41 399.8元）、总并发症发生率（11.2% vs. 21.3%）差异无统计学意义（均P>0.05）；两组术后均无结石残留。结论：完全腹腔镜下左肝蒂阻断行左半肝切除术治疗肝内外胆管结石安全、可行、有效，虽然手术时间稍长，但具有创伤小、疼痛轻、恢复快、住院时间短等优势，是一种值得推广的微创手术。
关键词：
胆结石
肝切除术
腹腔镜
（41 304.4元vs. 41 399.8元）、总并发症发生率（11.2% vs. 21.3%）差异无统计学意义（均P>0.05）；两组术后均无结石残留。结论：完全腹腔镜下左肝蒂阻断行左半肝切除术治疗肝内外胆管结石安全、可行、有效，虽然手术时间稍长，但具有创伤小、疼痛轻、恢复快、住院时间短等优势，是一种值得推广的微创手术。
Left hepatectomy with left hepatic pedicle occlusion for intra-and extrahepatic bile duct stones via total laparoscopic approach
CorrespondingAuthor:SI Yaqing Email: siyaqing2008@163.com
Abstract
Objective: To determine the feasibility, safety and effectiveness of total laparoscopic left hepatic pedicle occlusion and left hepatectomy in treatment of intra-and extrahepatic bile duct stones. Methods: The clinical data of 32 patients with intra- and extrahepatic bile duct stones undergoing surgical treatment (procedures compromised left hepatectomy, cholecystectomy, choledochotomy, choledochoscopic stone extraction and T-tube drainage) from September 2010 to December 2015 were retrospectively analyzed. Of the patients, 18 cases underwent total laparoscopic surgery with left hepatic pedicle occlusion (laparoscopic group) and 14 cases underwent traditional open surgery (laparotomy group). The relevant clinical variables between the two groups of patients were compared. Results: The preoperative data between the two groups of patients were comparable. All patients were operated successfully, and no conversion was required in laparoscopic group. In laparoscopic group compared with laparotomy group, the operative time was prolonged (273.0 min vs. 214.0 min, P<0.05) and the cost for surgery was increased (5 550.0 yuan vs. 3 962.0 yuan, P<0.05), but significant difference was noted in postoperative alanine aminotransferase level (postoperative day 1: 158.2 U/L vs. 291.5 U/L, postoperative day 7: 33.3 U/L vs. 52.2 U/L), time for pain relief (3.2 h vs. 5.0 h), time to first passage of gas (23.3 h vs. 45.5 h), and length of postoperative hospital stay (12.0 d vs. 15.7 d) (all P<0.05). There was no statistical significance in intraoperative blood loss (226.7 mL vs. 189.3 mL), total hospitalization costs (41 304.4 yuan vs. 41 399.8 yuan) and overall incidence of postoperative complications (11.2% vs. 21.3%) between the two groups (all P>0.05). No residual stone was seen in any of the patients in the two groups.
Conclusion: Total laparoscopic left hepatic pedicle occlusion and left hepatectomy is simple, safe and effective in treatment of intra-and extrahepatic bile duct stones. Although the operative time is somewhat prolonged, it has the advantages of less trauma and pain, as well as fast recovery and short hospitalization, so it deserves to be used in clinical practice.
Keywords：
Conclusion: Total laparoscopic left hepatic pedicle occlusion and left hepatectomy is simple, safe and effective in treatment of intra-and extrahepatic bile duct stones. Although the operative time is somewhat prolonged, it has the advantages of less trauma and pain, as well as fast recovery and short hospitalization, so it deserves to be used in clinical practice.