腹腔镜左肝叶切除治疗肝胆管结石

Laparoscopic left liver resection to treat intrahepatic lithiasis

目的探讨胆道镜联合腹腔镜左肝叶切除治疗肝胆管结石的可行性及临床疗效。方法选择肝胆管结石患者49例，全麻下行腹腔镜左肝外叶切除、左肝内叶切除、左半肝切除，联合胆道镜胆管探查取石。结果29例患者在完全腹腔镜下行解剖性左肝外叶切除（Ⅱ Ⅲ段），2例行左肝内叶切除（Ⅳ段），18例行左半肝切除（Ⅱ Ⅲ Ⅳ段）。所有患者均联合胆道镜胆管探查和取石，11例联合腹腔镜胆囊切除（LC）。平均手术时间为226min，联合LC者平均手术时间为243min。术中平均出血378ml。术后未发生胆漏和出血等并发症。术后1～3d肛门排气，胃肠功能恢复、进食，7～12d痊愈出院。患者术后复查MRI、MRCP未发现结石残留。随访47例，平均16个月，患者恢复良好，未发现结石再发。结论胆道镜联合腹腔镜左肝切除治疗肝胆管结石具有创伤小、恢复快、治疗彻底、临床疗效好等优点，是一种安全、有效、微创、可行的新手术方式。

Objective To study the feasibility and efficacy of intraoperative choledoscopy com- bined with laparoscopic left liver resection to treat intrahepatic lithiasis. Method In 49 patients with biliary stone, laparoscopic left lateral sectionectomy/left medial sectionectomy/left hepatectomy com- bined with intraoperative choledochoscopy and stone retrieval were carried out. Results Laparoscopic left lateral sectionectomy was carried out in 29 patients, left medial sectionectomy in 2 patients and left hepatectomy in 18 patients. In all the patients, combined choledoscopy and stone retrieval were carried out. A concomitant laparoscopic cholecystectomy （LC） was carried out in 11 patients. The average operative time was 226 min. When LC was carried out, the mean operative time was 243 min. The mean intraoperative blood loss was 378 ml. There was no bile leak or postoperative bleeding. Flatus was passed 1-3 days after surgery. The patients were discharged home 7-10 days after surgery. Post- operative MRI/MRCP did not reveal any residual stone. On a mean follow up of 16 months for 47 pa tients, the patients did well and there was no recurrent stonel Conclusion Choledochoscopy combined with laparoscopic left liver resection for bile duct stone resulted in minimal trauma to the patient. The recovery was quick and there was a high stone clearance rate. The treatment was safe, efficacious, and it is a viable minimally invasive treatment option.