免T管肝左外叶切除治疗肝内外胆管结石20例临床体会

T-tube-free left lateral hepatectomy for choledocholithiasis and hepatolithiasis:Clinical experience in 20 cases

目的：探讨免T管肝左外叶切除加术中胆道镜取石治疗胆总管结石合并肝左外叶胆管结石伴（或不伴）胆囊结石的安全性和可行性。方法：回顾性分析我院2013年1月～2015年8月肝左外叶胆管结石20例的临床资料,合并胆总管结石17例,胆囊结石14例。采用开腹手术方式切除左外叶及胆囊,术中使用胆道镜由左肝断面扩张胆管,探查左右肝管及胆总管,并取出胆总管结石,缝合左肝断面的胆管。结果：全部病例手术均获得成功,手术时间115～210 min,平均（162.5±29.7）min;术中出血量50～350 m L,平均（87.5±86.9）m L;术后住院天数为5～10 d,平均（7.3±1.6）d。术后有2例患者发生肝脏断面的胆漏,经腹腔冲洗,带管回家。两周后入院复查,拔除引流管,无胆漏发生。结论：肝叶（段）切除术是治疗肝内胆管结石的重要手段,结合胆道镜治疗可明显降低胆道结石的残留率。

Objective：To assess the safety and feasibility of left lateral hepatectomy combined with intraoperative cholangioscopy without T-tube drainage.Methods：The clinical data were retrospectively analyzed in 20 cases with left-sided hepatolithiasis managed by left lateral hepatectomy in our hospital between January 2013 and August 2015.Of the 20 cases,17 were concomitant with common bile duct stones,and 14,gallbladder stones.After left hepatectomy,removal of the extrahepatic bile duct stones and right hepatic duct exploration were carried out under choledochoscope through the left hepatic duct.Results：Operation was completed successfully in all cases.Mean operative time was（162.5 ± 29.7）min（range from 115 to 210 min）.Intra-operative blood loss was（87.5 ± 86.9）m L on average（range from 50 to 350 m L）,and mean hospital stay was（7.3 ± 1.6）days（ranging from 5 to 10 days）after operation.Two patients were complicated with bile leakage that was managed by irrigation of the peritoneal cavity and tube drainage that was removed after two weeks upon hospital visit.Conclusion：Left lateral hepatectomy for choledocholithiasis and hepatolithiasis can be safe and effective,and reduce the incidence of stone residuals in bile,if assisted with cholangioscopy.