腹腔镜区域肝血流阻断肝叶切除治疗肝胆管结石的临床价值(附122例报告)

Clinical value of selective portal inflow occlusion laparoscopic hepatectomy for hepatolithiasis

目的探讨腹腔镜区域肝血流阻断肝叶切除治疗肝胆管结石临床价值。方法 2005年10月～20012年4月该院施行237例腹腔镜区域肝血流阻断肝叶切除,其中122例为肝胆管结石,实施腹腔镜肝叶切除:72例左肝外叶切除,48例左半肝切除,2例左三联切除。结果 119例获得成功,3例中转开腹处理;手术时间120～420min,平均276min;出血量50～1000mL,平均325mL,输血3例;术后平均住院7d;7例术后胆漏经通畅引流而自愈,无死亡、出血、肝功能衰竭及膈下脓肿并发症发生;术后T管造影发现残石1例,术后胆道镜取出。结论腹腔镜区域肝血流阻断肝叶切除治疗肝胆管结石是安全可行的方法,但不同于其他病种腹腔镜肝叶切除,难度更大,应严格掌握指征。

【Objective】To explore the clinical value of hepatectomy with selective portal inflow occlusion on hepatolithiasis. 【Methods】Form October 2005 to April 2012, 122 hepatolithiasis patients were performed by laparoscopic hepatectomy with selective portal inflow occlusion. Procedure included left lateral segmentectomies (72 patients), left hemihepatectomies (48 patients) and left trisectionectomy (2 patients). 【Results】119 patients were performed laparoscopic hepatectomy successfully and 3 conversions to open surgery. The median operative time was 276 min (120-420 min). Blood loss during operation was 50-1000 mL (median 325 mL). 7 postoperative biliary fistula were cured by drainage. There are no mortality, no liver failure and no subphrenic abscess. One patient occurred residual calculus and was cured by choledochoscope. 【Conclusions】Laparoscopic hepatectomy with selective portal inflow occlusion is feasible and safe for selected patients with hepatolithiasis.