腹腔镜经左肝管断端探查取石治疗复发性肝内胆管结石的临床研究

Clinical Study of Laparoscopic Treatment for Recurrent Hepatolithiasis via Left Hepatic Duct Orifice

目的:探讨腹腔镜经左肝管断端探查取石治疗复发性肝胆管结石的临床治疗效果。方法:选取胆道手术史的肝内胆管结石患者67例,随机分为2组,观察组36例行左半肝切除术中经左肝管断端胆道探查取石术,对照组31例行左半肝切除术中经胆总管胆道探查取石术,比较2组手术时间、术中出血量、术后住院时间、术后并发症和残余胆管结石。结果:2组患者均未见残留结石;观察组手术时间[(172.6±20.2) min]、术后住院时间[(8.20±1.21) d]分别短于对照组[(189.7±20.8) min、(11.20±2.70) d],(P<0.05);术中出血量、术后并发症发生率,组间差异均无统计学意义(P>0.05)。结论:腹腔镜经左肝管断端探查取石术安全可行,其简化了手术流程,缩短了手术与住院时间,术后并发症低。

Objective: To investigate clinical efficacy of exploration and removing stone via left hepatic duct orifice for the treatment of recurrent hepatolithiasis. Methods: Sixty-seven patients of hepatolithiasis with history of biliary tract surgery were divided into two groups. Thirty-six cases for left hemihepatectomy with intraoperative biliary exploration via the left hepatic duct orifice were chosen as observation group, and thirty-one cases for the common bile duct were taken as control group. The clinical efficacy was evaluated by comparing operative time, intraoperative blood loss, postoperative hospital stay, postoperative complications and residual bile duct stones. Results: No residual stones were found in the two groups. Operation time and postoperative hospital stay in observation group were significantly shorter in the observation group(P<0.05). There was no significant difference in the amount of intraoperative bleeding and postoperative complications between two groups(P>0.05). Conclusion: Laparoscopy through probing left lateral hepatic duct was safe and feasible. It simplifies the operation process, shortens the operation and hospitalization time, and has low postoperative complications.