CAJ | 학술논문

目的探讨腹腔镜手术治疗区域型肝胆管结石病的疗效.方法回顾性分析2007年3月至2011年3月第三军医大学西南医院行腹腔镜手术治疗81例区域型肝胆管结石病患者的临床资料.对符合2007年《肝胆管结石病诊断治疗指南》分类标准和开腹手术指征的患者,在完善术前检查后根据结石部位采用腹腔镜下肝切除术切除病变肝叶(段),最大限度清除含有结石、狭窄及扩张的病变胆管,联合使用术中纤维或电子胆道镜对剩余肝叶(段)胆管及肝外胆管进行探查和(或)取石,防止结石残留.结果 81例患者中72例成功实施全腹腔镜下肝切除术,9例中转开腹.全组患者中行肝左外叶(肝Ⅱ、Ⅲ段)切除术20例,肝左叶(肝Ⅱ、Ⅲ、Ⅳ段)切除术30例,肝右后叶(肝Ⅵ、Ⅶ段)切除术11例,肝右前叶部分(肝Ⅴ、Ⅷ段)切除术6例,肝右叶(肝Ⅴ、Ⅵ、Ⅶ、Ⅷ段)切除术9例,肝Ⅲ段切除术2例,肝Ⅵ段切除术3例.手术常规切除胆囊,15例患者术中实施间歇性第一肝门人肝血流阻断.57例联合实施经胆总管切开或经左(右)肝管残端行术中胆道镜探查和(或)取石.本组患者平均手术时间( 328±80) min,术中平均出血量(451±288) ml,无手术死亡；16例出现术后并发症,包括肺部感染2例、反应性胸腔积液4例、肝断面包裹性积液6例、术后腹腔感染及脓肿2例、标本取出切口感染2例,其中9例采用药物治疗、6例行胸腔或腹腔穿刺引流、l例行切口清创,均治愈.本组患者平均住院时间(13±6)d.腹腔镜手术术中结石清除率为96％ (69/72),3例残留结石患者术后均经T管窦道胆道镜成功取出结石.69例患者随访时间7～55个月,7例患者仍有不同程度的月H管炎症状,2例患者出现胆总管结石复发,其余患者术后无结石复发.结论腹腔镜手术治疗区域型肝胆管结石病安全、可行.术前和术中对结石及病变肝段进行准确定位,正确规划肝实质离断平面,进行解剖性肝切除可以获得较好的疗效. 目的探討腹腔鏡手術治療區域型肝膽管結石病的療效.方法迴顧性分析2007年3月至2011年3月第三軍醫大學西南醫院行腹腔鏡手術治療81例區域型肝膽管結石病患者的臨床資料.對符閤2007年《肝膽管結石病診斷治療指南》分類標準和開腹手術指徵的患者,在完善術前檢查後根據結石部位採用腹腔鏡下肝切除術切除病變肝葉(段),最大限度清除含有結石、狹窄及擴張的病變膽管,聯閤使用術中纖維或電子膽道鏡對剩餘肝葉(段)膽管及肝外膽管進行探查和(或)取石,防止結石殘留.結果 81例患者中72例成功實施全腹腔鏡下肝切除術,9例中轉開腹.全組患者中行肝左外葉(肝Ⅱ、Ⅲ段)切除術20例,肝左葉(肝Ⅱ、Ⅲ、Ⅳ段)切除術30例,肝右後葉(肝Ⅵ、Ⅶ段)切除術11例,肝右前葉部分(肝Ⅴ、Ⅷ段)切除術6例,肝右葉(肝Ⅴ、Ⅵ、Ⅶ、Ⅷ段)切除術9例,肝Ⅲ段切除術2例,肝Ⅵ段切除術3例.手術常規切除膽囊,15例患者術中實施間歇性第一肝門人肝血流阻斷.57例聯閤實施經膽總管切開或經左(右)肝管殘耑行術中膽道鏡探查和(或)取石.本組患者平均手術時間( 328±80) min,術中平均齣血量(451±288) ml,無手術死亡；16例齣現術後併髮癥,包括肺部感染2例、反應性胸腔積液4例、肝斷麵包裹性積液6例、術後腹腔感染及膿腫2例、標本取齣切口感染2例,其中9例採用藥物治療、6例行胸腔或腹腔穿刺引流、l例行切口清創,均治愈.本組患者平均住院時間(13±6)d.腹腔鏡手術術中結石清除率為96％ (69/72),3例殘留結石患者術後均經T管竇道膽道鏡成功取齣結石.69例患者隨訪時間7～55箇月,7例患者仍有不同程度的月H管炎癥狀,2例患者齣現膽總管結石複髮,其餘患者術後無結石複髮.結論腹腔鏡手術治療區域型肝膽管結石病安全、可行.術前和術中對結石及病變肝段進行準確定位,正確規劃肝實質離斷平麵,進行解剖性肝切除可以穫得較好的療效.
목적 탐토복강경수술치료구역형간담관결석병적료효.방법 회고성분석2007년3월지2011년3월제삼군의대학서남의원행복강경수술치료81례구역형간담관결석병환자적림상자료.대부합2007년《간담관결석병진단치료지남》분류표준화개복수술지정적환자,재완선술전검사후근거결석부위채용복강경하간절제술절제병변간협(단),최대한도청제함유결석、협착급확장적병변담관,연합사용술중섬유혹전자담도경대잉여간협(단)담관급간외담관진행탐사화(혹)취석,방지결석잔류.결과 81례환자중72례성공실시전복강경하간절제술,9례중전개복.전조환자중행간좌외협(간Ⅱ、Ⅲ단)절제술20례,간좌협(간Ⅱ、Ⅲ、Ⅳ단)절제술30례,간우후협(간Ⅵ、Ⅶ단)절제술11례,간우전협부분(간Ⅴ、Ⅷ단)절제술6례,간우협(간Ⅴ、Ⅵ、Ⅶ、Ⅷ단)절제술9례,간Ⅲ단절제술2례,간Ⅵ단절제술3례.수술상규절제담낭,15례환자술중실시간헐성제일간문인간혈류조단.57례연합실시경담총관절개혹경좌(우)간관잔단행술중담도경탐사화(혹)취석.본조환자평균수술시간( 328±80) min,술중평균출혈량(451±288) ml,무수술사망；16례출현술후병발증,포괄폐부감염2례、반응성흉강적액4례、간단면포과성적액6례、술후복강감염급농종2례、표본취출절구감염2례,기중9례채용약물치료、6례행흉강혹복강천자인류、l례행절구청창,균치유.본조환자평균주원시간(13±6)d.복강경수술술중결석청제솔위96％ (69/72),3례잔류결석환자술후균경T관두도담도경성공취출결석.69례환자수방시간7～55개월,7례환자잉유불동정도적월H관염증상,2례환자출현담총관결석복발,기여환자술후무결석복발.결론복강경수술치료구역형간담관결석병안전、가행.술전화술중대결석급병변간단진행준학정위,정학규화간실질리단평면,진행해부성간절제가이획득교호적료효.
Objective To investigate the efficacy of laparoscopic hepatectomy for regional hepatolithiasis.Methods The clinical data of 81 patients with regional hepatolithiasis who received laparoscopic hepatectomy at the Southwest Hospital from March 2007 to March 2011 were retrospectively analyzed.Based on the classification of the Guideline for the diagnosis and treatment of hepatolithiasis 2007 version and indications for open surgery,hepatic lobes with calculi,biliary stricture or dilated bile ducts were resected laparoscopically after preoperative examination.Bile ducts of the remnant hepatic lobes were explored using fiber choledochoscope or electronic choledochoscope for the prevention of residual stones. Results Laparoscopic hepatectomy was successfully performed on 72 patients,and the other 9 patients were converted to open surgery. Left lateral lobectomy ( segments Ⅱ,Ⅲ ) was performed on 20 patients,left hemihepatectomy ( segments Ⅱ,Ⅲ,Ⅳ ) on 30 patients,right posterior lobectomy ( segments Ⅵ,Ⅶ ) on 11 patients,right anterior lobectomy ( segments Ⅴ,Ⅷ ) on 6patients,right hemihepateetomy (segments Ⅴ,Ⅵ,Ⅶ,Ⅷ ) on 9 patients,hepatic Ⅲ segmentectomy on 2 patients and hepatic Ⅵ segmentectomy on 3 patients.Gallbladders were resected,and intermittent portal triad clamping was performed on 15 patients.Hepateetomy combined with biliary exploration and stone removal was performed on 57 patients.The mean operation time and operative blood loss were (328 ± 80)minutes and (451 ±288) ml,respectively.No operative mortality was observed.Sixteen patients had postoperative complications,including pulmonary infection in 2 patients,pleural effusion in 4 patients,encapsulated effusion in the resection margin in 6 patients,abdominal infection and abscess in 2 patients and wound infection in 2 patients.Of the 16patients with complications,9 were cured by medicine,6 by pleural or abdominal drainage and 1 by wound debridement.The mean duration of hospital stay was ( 13 + 6)days.The intraoperative stone clearance rate was 96％ (69/72),and the residual stone in 3 patients were removed by choledochoscopy.Sixty-nine patients were followed up for 7-55 months,7 patients had symptoms of cholangitis and 2 patients had common bile duct stone recurrence.Conclusions Laparoscopie hepatectomy is sate and effective for regional hepatolithiasis.Accurate positioning of the stones and lesions pre- and intra-operatively,reasonable designing of the parenchymal transection plane,and anatomical liver resection are the key points for achiving good therapeutic effects.