肝内胆管结石病腹腔镜肝切除的关键技术与流程优化

Key techniques and procedure optimization of laparoscopic hepatectomy for hepatolithiasis

肝内胆管结石病简称肝石病,是我国常见而难治的良性胆道疾患.循证医学研究表明腹腔镜肝切除安全有效.但肝石病有其自身独特的临床病理特点,在精准肝切除及加速康复外科时代,其腹腔镜肝切除亦有自身的关键技术和操作流程.关键技术包括个体化操作孔选择、入肝血流阻断、解剖性肝切除、精细断肝和其他联合技术等.其合理操作流程可能为先行肝切除,后行肝外胆管切开取石;肝切除时应优先解剖肝门、阻断患侧入肝血流,再离断肝周韧带和黏连.

Hepatolithiasis is a common and refractory benign biliary tract disease in China. Meta-analyses show that laparoscopic hepatectomy （LH） is safe and effective for this disease. LH for hepatolithiasis has its distinctive techniques and procedures due to its unique clinicopathological characteristic in the era of precise hepatecomy and enhanced recovery after surgery. The key techniques include individualized selection of operating hole, hepatic inflow occlusion, anatomical hepatectomy, fine dissection, and other combined techniques. As for procedures, hepatecomy should be completed before extrahepatic bile duct choledocholithotomy is performed, and the portal hepatis should be preferentially dissected before the perihepatic ligaments are separated.