半肝入肝血流阻断左半肝切除术治疗肝内胆管结石(附54例报告)

Left hemihepatectomy under half hemihepatic vascular inflow occlusion for hepatolithiasis:A report of 54 cases

目的总结半肝入肝血流阻断左半肝切除术治疗肝内胆管结石的临床经验。方法回顾性分析2012年6月至2017年6月解放军第一一三医院采用半肝入肝血流阻断下左半肝切除治疗肝内胆管结石54例患者的临床资料。结果54例患者中,无围术期死亡患者;24例腹腔镜左半肝切除中2例腹腔镜中转开腹,22例顺利完成;30例行开腹左半肝切除术;全部采用鞘内半肝入肝血流阻断;术中出血(467±282)ml。术后切口感染15例(27.8%),胆漏7例(13.0%),腹腔感染4例(7.4%),胸腔积液16例(29.6%),肝创面积液2例(3.7%),无胆道及腹腔出血,无肝功能衰竭;术后2周结石清除率为81.5%(44/54),术后12周最终结石清除率为92.6%(50/54);随访0.5~5.0年,发现结石复发2例,无再次手术患者,无迟发性胆管癌患者。结论左半肝切除是治疗左肝胆内管结石的有效术式,半肝入肝血流阻断术应用于左半肝切除可以增加手术安全性。

Objective To summarize the experience on left hemihepatectomy under half hemihepatic vascular inflow occlusion for treatment of hepatolithiasis.Methods The clinical data of 54 patients suffering from intrahepatic bile duct stones,who had undergone left hemihepatectomy under half hemihepatic vascular inflow occlusion in the 113th Hospital of People’Liberation Army from June 2012 to June 2017,were retrospectively analyzed.Results No one dead in perioperative period among the 54 patients.Twenty-four patients underwent laparoscopic left hemihepatectomy;of them,two cases changed to undego open surgery and 22 cases successfully completed laparoscopic operation.Thirty patients were treated by open hemihepatectomy with half hemihepatic vascular inflow occlusion.The Glisson intrapedicel vascular inflow occlusion techniques were used for 54 patients.The average intraoperative blood loss was(467±282)ml.Postoperative incision infection occurred in 15 cases(27.8%),bile leakage was found in seven cases(13.0%),abdominal infection developed in four cases(7.4%),pleural effusion occurred in 16 cases(29.6%)and effusion the resection margin was found in two cases(3.7%).There was no liver failure,intrabdominal hemorrhage or hemobilia.Stone clearance rate at two weeks after operation was 81.5%(44/54),and final stone clearance rate at 12 weeks after operation was 92.6%(50/54).During 0.5 to 5.0-year follow-up,stone recurred in two cases,but there was no repeat surgery and cholangiocarcinoma.Conclusions Left hemihepatectomy is an effective treatment method of left hepatolithiasis,and the procedure can promote safety of surgery selective occlusion of the hepatic inflow.