腹腔镜肝切除联合术中胆道镜治疗左肝内胆管结石56例临床分析

Clinical analysis of 56 patients with left hepatolithiasis treated by laparoscopic hepatectomy combined with intraoperative choledochoscopy

目的探讨腹腔镜肝叶切除联合术中胆道镜治疗左肝内胆管结石的安全性及有效性。方法回顾性分析我院2014年1月至2019年1月收治的56例腹腔镜肝切除联合术中胆道镜治疗左肝内胆管结石患者的临床资料。结果本组患者中腹腔镜左肝外叶切除+胆道探查取石+T管引流20例(35.7%),腹腔镜左半肝切除+胆道探查取石+T管引流34例(60.7%),中转开腹左半肝切除2例(3.6%)。手术时间(210±78)min,术中出血(700±400)ml,住院时间(15.4±6.8)d。术后胆漏2例(3.6%),转氨酶升高超正常值3倍及以上者6例(10.7%),左侧胸腔积液2例(3.6%),胆道残余结石4例(7.1%),无术后出血、膈下脓肿、肝功能衰竭、切口感染等并发症发生。术后随访3~24月无胆管结石复发。结论腹腔镜肝切除联合术中胆道镜治疗左肝内胆结石具有创伤小、并发症少等优点,是安全和有效的。

Objective To investigate the safety and efficacy of laparoscopic left hepatectomy combined with intraoperative choledochoscopy for hepatolithiasis.Methods The clinical data of 56 patients undergone laparoscopic hepatectomy and choledochoscope for left hepatolithiasis between January 2014 and January 2019 in our hospital were retrospectively reviewed.Results There were 20 patients with laparoscopic left lateral lobectomy+choledochotomy+T tube drainage(35.7%),34 patients with laparoscopic left hemihepatectomy+choledochotomy+T tube drainage(60.7%),and 2 patients with conversion to laparotomy for left hemihepatectomy(3.6%).The operation time was(210±78)min,intraoperative bleeding was(700±400)ml and the average hospital stay was(15.4±6.8)days.The postoperative complications included 2 cases with bile fistula(3.6%),6 cases with transaminase elevation(10.7%),2 cases with left pleural effusion(3.6%)and 4 cases with residual stone in biliary(7.1%).There were no complications such as bleeding,subdiaphragmatic abscess,liver failure and incision infection.No recurrence of cholangiolithiasis was found during 3~24 months of follow-up.Conclusion Laparoscopic left hepatectomy combined with intraoperative choledochoscopy for the treatment of left hepatolithiasis has the advantages of less trauma and fewer complications.The method is safe and effective.