腹腔镜左半肝切除术治疗肝胆管结石的应用研究

腹腔镜左半肝切除术治疗肝胆管结石的应用研究
肖昌武;邱容;李宁
【期刊名称】《腹腔镜外科杂志》
【年(卷),期】2016(021)012
【摘要】Objective:To investigate the practicability of the totally laparoscopic left hepatectomy for the treatment of left hepa -
tolithiasis .Methods:Clinical data of 33 patients who suffered from left hepatolithiasis and underwent laparoscopic left hepatectomy from
Jun.2013 to Sep.2015 were retrospectively analyzed .Laparoscopic left hemihepatectomy ,bile duct exploration and T tube placement were performed in these patients during operations .All the patients received color Doppler ultrasound examinations and computed tomo-
graphy ,choledochoscopy or T tube cholangiography in 6 weeks after surgery to determine whether there were postoperative complications such as residual calculi and so on .All the patients were followed
up .Results:Operations of 31 cases were successfully completed ,2 ca-ses were converted to open surgery .Vital signs of those patients were smooth during operation .The operation time was (177 ±56) min, blood loss was (317 ±57) ml during operations.The patients could take food after 24-48 h with the average of (29.0 ±15.3) h.The drainage tube was removed after 48 to 72 h.There were 1 case of bile leakage which was cured after drainage ,1 case with incision infec-tion was cured after dressing change and
adjustment of blood sugar ,and 1 case with subphrenic effusion was cured by puncture and drainage.The patients stayed in hospital for (8.7 ±1.7) d after operation.During the follow-up of 1-24 months,all patients recovered well without bile duct stricture or calculi
recurrence .Conclusions:Laparoscopic left hemihepatectomy by experienced surgeon is safe , feasible and effective in the treatment of left hepatolithiasis .This procedure is worth clinical application and popularization .%目的：探讨完全腹腔镜左半肝切除术治疗左肝胆管结石病的临
床应用价值。

方法：回顾分析2013年6月至2015年9月为33例左肝胆管结石患者行腹腔镜左半肝切除术的临床资料。

在腹腔镜下行左半肝切除、胆道检查并放置T管。

术后6周行超声、CT、胆道镜检查或T管造影了解有无结石残留等并发症。

患者均得到随访。

结果：31例患者顺利完成腹腔镜手术，2例中转开腹，术
中生命体征平稳，手术时间平均（177±56） min，术中出血量平均（317±57）ml，术后胃肠功能恢复时间24～48 h，平均（29．0±15．3） h，术后48～72 h拔除腹腔引流管。

术后1例发生胆漏，经引流后痊愈；1例出现切口感染，经加强换药、调整血糖后痊愈，1例患者出现膈下积液，行穿刺引流治愈。

平均住院（8．7±1．7） d。

术后随访1～24个月，均恢复良好，无胆道狭窄、结石复发
等并发症发生。

结论：由经验丰富的腹腔镜医师开展腹腔镜左半肝切除术治疗左肝胆管结石是安全、可行的，值得临床推广应用。

【总页数】4页(P911-914)
【作者】肖昌武;邱容;李宁
【作者单位】遂宁市中心医院，四川遂宁，629000;遂宁市中心医院，四川遂宁，629000;四川大学华西医院
【正文语种】中文
【中图分类】R657.3
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