腹腔镜半肝切除术治疗肝内胆管结石53例

Application of laparoscopic hemihepatectomy in the treatment of hepatolithiasis: a report of 53 cases

目的探讨腹腔镜半肝切除术在肝内胆管结石治疗中的疗效。方法回顾性分析2009年3月至2016年8月广东省中医院收治的53例肝内胆管结石患者的临床资料,患者均接受腹腔镜半肝切除术治疗。结果 53例患者中6例行腹腔镜右半肝切除术,47例行腹腔镜左半肝切除术,手术时间为145(110~280)min,术中出血量为240(50~600)ml,术后住院时间为9(6~21)d。无一例出现围手术期死亡。术后并发症发生率为15.1%(8/53),发生胆瘘2例,胸腔积液6例。术后发生残留结石8例(15.1%),其中4例术后胆道镜经T管窦道取净结石,最终结石残留率7.5%。50例(94.3%)获得随访,中位随访26.5个月,47例(94.0%)无再发胆管结石。结论腹腔镜半肝切除术治疗肝内胆管结石安全可行、有效。

Objective To evaluate the application of laparoscopic hemihepatectomy in hepatolithiasis. Methods The clinical data of fifity three patients with hepatolithiasis underwent laparoscopic hemihepatectomy in Guangdong Provincial TCM Hospital between March 2009 and August 2016 were analyzed retrospectively. Results 6 patients underwent laparoscopic right hemihepatectomy, and 47 received laparoscopic left hemihepatectomy. The mean operative time was 145（110-280） minutes, the mean blood loss was 240（50-600） ml. The average hospital stay was 9（6-21） d. No perioperative death occurred. The incidence of postoperative complications was 15.1%（8/53）,including 2 of bile leakage and 6 of pleural effusion. There were 8 cases（15.1%） of postoperative residual stones, 4 of whom were completely extracted via postoperative choledochoscopy. 50 cases（94.3%） were successfully followed-up with median time of 26.5 months. 47 cases（94.0%） had no recurrent bile duct stones. Conclusion Laparoscopic hepatectomy is safe and effective in the treatment of hepatolithiasis.