腹腔镜肝切除术在复杂肝内胆管结石患者中的应用

Application of laparoscopic hepatectomy in patients with complex hepatolithiasis

目的探讨腹腔镜肝切除术在复杂肝内胆管结石患者中的应用效果。方法回顾性分析2015年1月至2019年9月期间于笔者所在医院接受腹腔镜肝切除术治疗的31例复杂肝内胆管结石患者的临床资料,并随访观察其效果。结果本组31例患者中,中转开腹2例,其余29例顺利完成腹腔镜手术。31例患者的手术时间185~490 min、(260±106)min;术中出血量200~1300 mL、(491±225)mL;入肝血流阻断时间20~45 min、(29±18)min;胆道镜检查时间10~50 min、(28±15)min。肝切除范围包括:Ⅱ、Ⅲ、Ⅵ及Ⅶ段14例,Ⅰ、Ⅱ、Ⅲ、Ⅵ及Ⅶ段8例,Ⅱ、Ⅲ、Ⅳ、Ⅵ及Ⅶ段3例,Ⅳ、Ⅴ及Ⅷ段3例,Ⅱ、Ⅲ、Ⅴ、Ⅵ、Ⅶ及Ⅷ段2例,Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅵ及Ⅶ段1例。术后肛门排气时间24~73 h、(41.8±15.2)h;术后进食时间14~23 h,中位进食时间19 h;术后下床活动时间15~46 h,中位下床活动时间27 h;术后引流管拔出时间3~14 d,中位引流管拔出时间5 d;术后住院时间6~15 d,中位术后住院时间9 d。27例患者获得随访,随访时间为7~63个月,中位随访时间25个月。术后并发症发生率为19.4%(6/31),按Clavein分级:Ⅰ级2例(6.5%),Ⅱ级1例(3.2%),Ⅲa级3例(9.7%)。结论采用腹腔镜肝切除的方法治疗复杂肝内胆管结石时,由腹腔镜操作熟练的肝胆外科团队实施安全且可行。

Objective To explore the effect of laparoscopic hepatectomy in patients with complex hepatolithiasis.Methods The clinical data of 31 patients with complex hepatolithiasis treated by laparoscopic hepatectomy in our hospital from January 2015 to September 2019 were retrospectively analyzed,and the effect was followed up.Results Two cases were converted to open surgery,and the remaining 29 cases successfully completed laparoscopic surgery.The operative time of 31 patients was 185–490 min(260±106)min;the intraoperative bleeding volume was 200–1300 mL(491±225)mL;the time of hepatic blood flow occlusion was 20–45 min(29±18)min;the time of choledochoscopy was 10–50 min(28±15)min.The scope of hepatectomy includes:Ⅱ,Ⅲ,Ⅵ,andⅦin 14 cases,Ⅰ,Ⅱ,Ⅲ,Ⅵ,andⅦin 8 cases,Ⅱ,Ⅲ,Ⅳ,Ⅵ,andⅦin 3 cases,Ⅳ,Ⅴ,andⅧin 3 cases,Ⅱ,Ⅲ,Ⅴ,Ⅵ,Ⅶ,andⅧin 2 cases,Ⅰ,Ⅱ,Ⅲ,Ⅳ,Ⅵ,andⅦin 1 case.The postoperative anal exhaust time was 24–73 h(41.8±15.2)h;postoperative feeding time was 14–23 h,median feeding time was 19 h;postoperative ambulation time was 15–46 h,median ambulation time was 27 h;postoperative drainage tube extraction time was 3–14 d,median drainage tube extraction time was 5 d;postoperative hospitalization time was 6–15 d,median postoperative hospitalization time was 9 d.Twenty-seven patients were followed up for 7 to 63 months,with a median follow-up time of 25 months.The incidence of complications was 19.4%(6/31),according to Claviein classification,there were 2 cases in gradeⅠ(6.5%),1 case in gradeⅡ(3.2%),3 cases in gradeⅢa(9.7%).Conclusion Laparoscopic hepatectomy is safe and feasible for the treatment of complex hepatolithiasis,which is performed by a skilled hepatobiliary surgeon.