腹腔镜肝切除术在肝内胆管结石治疗中的应用

Application of Laparoscopic Hepatectomy in Hepatolithiasis

目的探讨腹腔镜肝切除术在肝内胆管结石治疗中的应用价值。方法回顾性分析笔者所在医院2003年11月至2012年11月期间采用腹腔镜肝切除术治疗的35例肝内胆管结石患者的临床资料。手术方式包括腹腔镜肝左外叶切除、左半肝切除、胆囊切除、胆总管切开探查取石、胆道镜探查取石、T管引流等。结果 35例患者的手术均完全在腹腔镜下完成,平均手术时间为205 min(150～370 min),术中平均出血量为330 mL(50～1 000 mL)。术后患者痛苦轻,均未用止痛药。术后1 d即可下床活动,2 d恢复流质饮食,术平均后住院时间为12.3 d(4～15 d)。无死亡病例;手术优、良率分别为71.4%和25.7%。结论选择合适的病例,腹腔镜肝切除术治疗肝内胆管结石是一项微创、有效的可供选择的治疗方法之一。

Objective To evaluate the value of the application of laparoscopic hepatectomy in hepatolithiasis. Methods The clinical data of 35 patients with hepatolithiasis performed with laparoscopic hepatectomy were analyed retrospectively. Operations included laparoscopic left lateral sectionectomy, left hemihepatectomy, cholecystectomy, choledoeholithotomy, choledochoscopy, and T-tube drainage. Results All operations of 35 patients were performed complete laparoscopically. The mean operative time was 205 minutes （150-370 minutes）. The mean blood loss was 330 mL （50-1 000 mL）. Patients felt less pain without administration ofpainkillers after operation. Ambulation resumed on the first day and liquid diet resumed on the second day after operation. The average hospital stay was 12. 7 days （4-15 d）. There was no death. The excellent and good rate of operation was 71.4% and 25.7%, respectively. Conclusion Laparoscopic hepatetomy is an effect and minimally invasive alternative method for hepatolithiasis in slective patients.