中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2015年
7期
520-524
,共5页
刘天锡%方登华%关斌颖%杨国际%王星入
劉天錫%方登華%關斌穎%楊國際%王星入
류천석%방등화%관빈영%양국제%왕성입
胆结石%腹腔镜%肝切除术%左纵沟
膽結石%腹腔鏡%肝切除術%左縱溝
담결석%복강경%간절제술%좌종구
Cholelithiasis%Laparoscopes%Hepatectomy
目的 探讨腹腔镜经左纵沟入路解剖性左肝切除的可行性及临床效果.方法 选择左肝内胆管结石患者103例,全麻下腹腔镜经左纵沟入路解剖性左肝外叶切除39例,左半肝切除20例,经左肝膈面入路左肝外叶切除29例,经第一肝门入路左半肝切除15例.结果 103例行完全腹腔镜左肝切除,成功101例,2例中转开腹.101例中完全腹腔镜左肝外叶切除(Ⅱ、Ⅲ段)68例,经左纵沟组与经镰状韧带左侧肝膈面入路组相比,手术时间显著缩短(t=-2.723,P=0.008),术中出血量明显减少(t=-5.399,P=0.000),但在术后住院时间(t=-0.168,P=0.867)及术后并发症(x2 =0.664,P=0.415)2组差异无统计学意义.完全腹腔镜左半肝切除(Ⅱ、Ⅲ、Ⅳ段)33例,其中经左纵沟组与经第一肝门组相比,手术时间显著缩短(t=-3.144,P=0.004),2组术中出血量差异无统计学意义(t=-1.049,P=0.302),术后住院时间差异无统计学意义(t=0.784,P=0.439).本组2例中转开腹.全组术后无大出血和顽固性胆漏(需再行手术干预者)及气体栓塞等并发症.术后1 ～4d肛门排气,平均(2.5±1.2)d,术后5～17d痊愈出院,平均(9.98±2.98)d.完全腹腔镜左肝切除101例,随访96例,失访5例.随访3～52 (32.6±5.7)个月,术后复查未发现肝内外胆管结石残留.经第一肝门组术后复查CT提示肝尾状叶萎缩1例.结论 腹腔镜经左纵沟入路解剖性左肝切除具有创伤小、恢复快、治疗彻底、便于操作等优点,是一种安全、有效、微创的手术方式.
目的 探討腹腔鏡經左縱溝入路解剖性左肝切除的可行性及臨床效果.方法 選擇左肝內膽管結石患者103例,全痳下腹腔鏡經左縱溝入路解剖性左肝外葉切除39例,左半肝切除20例,經左肝膈麵入路左肝外葉切除29例,經第一肝門入路左半肝切除15例.結果 103例行完全腹腔鏡左肝切除,成功101例,2例中轉開腹.101例中完全腹腔鏡左肝外葉切除(Ⅱ、Ⅲ段)68例,經左縱溝組與經鐮狀韌帶左側肝膈麵入路組相比,手術時間顯著縮短(t=-2.723,P=0.008),術中齣血量明顯減少(t=-5.399,P=0.000),但在術後住院時間(t=-0.168,P=0.867)及術後併髮癥(x2 =0.664,P=0.415)2組差異無統計學意義.完全腹腔鏡左半肝切除(Ⅱ、Ⅲ、Ⅳ段)33例,其中經左縱溝組與經第一肝門組相比,手術時間顯著縮短(t=-3.144,P=0.004),2組術中齣血量差異無統計學意義(t=-1.049,P=0.302),術後住院時間差異無統計學意義(t=0.784,P=0.439).本組2例中轉開腹.全組術後無大齣血和頑固性膽漏(需再行手術榦預者)及氣體栓塞等併髮癥.術後1 ～4d肛門排氣,平均(2.5±1.2)d,術後5～17d痊愈齣院,平均(9.98±2.98)d.完全腹腔鏡左肝切除101例,隨訪96例,失訪5例.隨訪3～52 (32.6±5.7)箇月,術後複查未髮現肝內外膽管結石殘留.經第一肝門組術後複查CT提示肝尾狀葉萎縮1例.結論 腹腔鏡經左縱溝入路解剖性左肝切除具有創傷小、恢複快、治療徹底、便于操作等優點,是一種安全、有效、微創的手術方式.
목적 탐토복강경경좌종구입로해부성좌간절제적가행성급림상효과.방법 선택좌간내담관결석환자103례,전마하복강경경좌종구입로해부성좌간외협절제39례,좌반간절제20례,경좌간격면입로좌간외협절제29례,경제일간문입로좌반간절제15례.결과 103례행완전복강경좌간절제,성공101례,2례중전개복.101례중완전복강경좌간외협절제(Ⅱ、Ⅲ단)68례,경좌종구조여경렴상인대좌측간격면입로조상비,수술시간현저축단(t=-2.723,P=0.008),술중출혈량명현감소(t=-5.399,P=0.000),단재술후주원시간(t=-0.168,P=0.867)급술후병발증(x2 =0.664,P=0.415)2조차이무통계학의의.완전복강경좌반간절제(Ⅱ、Ⅲ、Ⅳ단)33례,기중경좌종구조여경제일간문조상비,수술시간현저축단(t=-3.144,P=0.004),2조술중출혈량차이무통계학의의(t=-1.049,P=0.302),술후주원시간차이무통계학의의(t=0.784,P=0.439).본조2례중전개복.전조술후무대출혈화완고성담루(수재행수술간예자)급기체전새등병발증.술후1 ～4d항문배기,평균(2.5±1.2)d,술후5～17d전유출원,평균(9.98±2.98)d.완전복강경좌간절제101례,수방96례,실방5례.수방3～52 (32.6±5.7)개월,술후복사미발현간내외담관결석잔류.경제일간문조술후복사CT제시간미상협위축1례.결론 복강경경좌종구입로해부성좌간절제구유창상소、회복쾌、치료철저、편우조작등우점,시일충안전、유효、미창적수술방식.
Objective To evaluate left liver anatomical resection via left vertical groove by laparoscope.Method Among 103 patients with left intrahepatic biliary calculi,39 cases underwent left lateral hepatectomy,20 cases did left liver anatomical resection via left vertical groove by laparoscope,29 cases underwent left lateral hepatectomy via left liver diaphragmatic surface,15 cases did left liver anatomical resection via the first porta.Result In the 103 cases of laparoscopic left liver anatomical resection,101 cases were successful and two cases were conversed to open surgery.In the success group,total laparoscopic anatomical left lateral lobectomy was performed (Ⅱ,Ⅲ section) in 68 cases.Compared with the approach via left liver falciform ligament diaphragmatic surface,the operatve time via left vertical groove was significantly shorter(t =-2.723,P =0.008,intraoperative blood loss was significantly smaller (t =-5.399,P =0.000),while the differences in postoperative hospital stay (t =-0.168,P =0.867) and postoperative complications (x2 =0.664,P =0.415) were of no statistical significance between the 2 groups.In the 33 cases of left hemihepatectomy (Ⅱ,Ⅲ,Ⅳ section),those performed via left vertical groove compared with through the first porta hepatic,used shorter operation time(t =-3.144,P =0.004),while blood loss was similar(t =-1.049,P =0.302),as well as the length of hospital stay(t =0.784,P =0.439).There was no postoperative bleeding and intractable bile leakage,nor postoperative air embolism.Flatus on an average of (2.5 ± 1.2) days.Patients were discharged from hospital 5-17 (9.98 ±2.98) days post-op.96 cases were followed up in the 101 cases undergoing successful total laparoscopic left hemihepatectomy.The followed-up time were 3-52 (32.6 ± 5.7) months.Postoperative review found no residue stone.One case in first porta hepatis group,caudate lobe atrophy was found by postoperative CT.Conclusions Left liver anatomical resection via left vertical groove by laparoscope is less traumatic,quick recovery with satisfactory clinical curative effect for the treatment of left hepatolithiasis.
