CAJ | 학술논문

目的探讨腹腔镜左半肝切除术治疗肝胆管结石的临床疗效.方法回顾性分析2013年6月至2014年6月南昌大学第二附属医院收治的30例行腹腔镜左半肝切除术治疗左肝胆管结石患者的临床资料.在腹腔镜下先行鞘内或鞘外半肝血流阻断后再切除左半肝,合并胆总管结石或右肝管结石一同处理,根据胆管情况选择放置T管或腹腔镜下行一期胆总管缝合.术后1个月均返院复查彩色多普勒超声、CT或者T管造影检查,此后每3个月复查彩色多普勒超声,必要时增加CT或MRI检查,了解有无结石残留等并发症.随访时间截至2014年7月.结果 5例患者中转开腹,25例患者顺利完成腹腔镜手术,全部采用阻断左半肝入肝血流后行肝切除术,其中鞘外阻断11例,鞘内阻断14例.手术时间为(158±85) min,术中出血量为(405±215) mL,术中输血2例.8例胆总管结石患者术中胆道镜探查未发现结石残留,其中5例行胆道一期缝合,3例放置T管.全组患者无手术死亡,术后2例发生胆汁漏,1例出现胸腔积液,经引流后痊愈;术后1例患者出现膈下积液,B超定位下行穿刺引流;术后1例患者出血,出血量约500 mL,经保守治疗痊愈.全组患者住院时间为(8.5 ±2.3)d.患者术后随访时间为1 ～12个月,无胆汁漏及腹腔感染等并发症,均无结石复发.结论腹腔镜左半肝切除术治疗肝胆管结石安全、可行,疗效良好.
목적 탐토복강경좌반간절제술치료간담관결석적림상료효.방법 회고성분석2013년6월지2014년6월남창대학제이부속의원수치적30례행복강경좌반간절제술치료좌간담관결석환자적림상자료.재복강경하선행초내혹초외반간혈류조단후재절제좌반간,합병담총관결석혹우간관결석일동처리,근거담관정황선택방치T관혹복강경하행일기담총관봉합.술후1개월균반원복사채색다보륵초성、CT혹자T관조영검사,차후매3개월복사채색다보륵초성,필요시증가CT혹MRI검사,료해유무결석잔류등병발증.수방시간절지2014년7월.결과 5례환자중전개복,25례환자순리완성복강경수술,전부채용조단좌반간입간혈류후행간절제술,기중초외조단11례,초내조단14례.수술시간위(158±85) min,술중출혈량위(405±215) mL,술중수혈2례.8례담총관결석환자술중담도경탐사미발현결석잔류,기중5례행담도일기봉합,3례방치T관.전조환자무수술사망,술후2례발생담즙루,1례출현흉강적액,경인류후전유;술후1례환자출현격하적액,B초정위하행천자인류;술후1례환자출혈,출혈량약500 mL,경보수치료전유.전조환자주원시간위(8.5 ±2.3)d.환자술후수방시간위1 ～12개월,무담즙루급복강감염등병발증,균무결석복발.결론 복강경좌반간절제술치료간담관결석안전、가행,료효량호.
Objective To explore the clinical efficacy of laparoscopic left hemihepatectomy for the treatment of intrahepatic bile duct stones.Methods The clinical data of 30 patients with left intrahepatic bile duct stones who were admitted to the Second Affiliated Hospital of Nancbang University from June 2013 to June 2014 were retrospectively analyzed.All the patients underwent laparoscopic left hemihepatectomy by the Glisson intra-and extra-pedicles vascular inflow occlusion techniques together with the removal of choledocholithiasis and right bile duct stones,and T tube placement or laparoscopic primary suture of common bile duct were selected according to the condition of bile duct.All the 30 patients were readmitted to hospital and detected by color Doppler ultrasound (CDUS),computed tomography (CT) and T tube cholangiography at postoperative month 1,and then received CDUS reexamination every 3 months.CT and MRI reexaminations were applied to patients with complication of residual stones if necessary.All the patients were followed up till July 2014.Results All the 30 patients were treated by laparoscopic hepatectomy with left hemihepatic vascular inflow occlusion,including 5 with conversion to open surgery and 25 with successful operation.The Glisson extra-and intra-pedicel vascular inflow occlusion techniques were used in 11 and 14 patients,respectively.The operation time and volume of blood loss were (158 ± 85) minutes and (405 ± 215) mL.Two patients received intraoperative blood transfusion.There were no residual stones in the 8 patients with choledocholithiasis by intraoperative choledochoscope,and primary suture of bile duct and T tube placement were done in 5 and 3 patients,respectively.No patients died.After operation,there were 2 patients with bile leakage and 1 with pleural effusion,and they were cured though drainage.One patient with subphrenic effusion was cured by B ultrasound-guided puncture and drainage.One patient had bleeding with the volume of blood loss of 500 mL,and was cured by conservative treatment.The duration of hospital stay in all the patients was (8.5 ± 2.3)days.No bile leakage and abdomen infection were detected by outpatient examination.The time of followup was 1-12 months,without recurrence of stones.Conclusion Laparoscopic left hemihepatectomy for the treatment of left intrabepatic bile duct stones is safe and feasible with satisfactory outcome.