Laennec膜入路的肝切除在左肝内胆管结石中的应用

Application of Laennec membrane approach hepatectomy in the management of left intrahepatic bile duct stones

目的探索Laennec膜入路为主的肝切除在左肝内胆管结石中的安全性、可行性和应用价值。方法选取2021年1月至2023年7月萍乡市人民医院收治因左肝内胆管结石(可同时合并肝外胆道系统结石)的60例患者作为研究对象,采用随机数字表法分为观察组与对照组,每组30例。所有患者均行腹腔镜左肝(含左半肝和左外叶)切除术,观察组采用Laennec膜入路为主,对照组采用Glisson鞘或肝静脉入路为主。比较两组围手术期指标、肝功能指标、残石率及并发症发生率。结果观察组围手术期各指标水平均优于对照组,差异有统计学意义(P<0.05);两组手术前肝功能各指标水平比较,差异无统计学意义(P>0.05),观察组手术后丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、直接胆红素(DBil)水平均低于对照组,差异有统计学意义(P<0.05);观察组残石率、并发症总发生率均低于对照组,差异有统计学意义(P<0.05)。结论Laennec膜入路为主的解剖性肝切除在左肝内胆管结石患者治疗中获得显著效果,残石率较低,并发症较少,临床应用安全可靠,值得推广。

Objective To explore the safety,feasibility and application value of Laennec membrane approach based hepatectomy in the treatment of left intrahepatic bile duct stones.Methods A total of 60 patients with left intrahepatic bile duct stones(which can be combined with extrahepatic bile duct stones)admitted to Pingxiang People's Hospital from January 2021 to July 2023 were selected and divided into the observation group and the control group by random number table method,with 30 cases in each group.All patients underwent laparoscopic left liver resection(including left half liver and left outer lobe).Laennec membrane approach was used in the observation group,and Glisson sheath or hepatic vein approach was used in the control group.Perioperative indexes,liver function indexes,residual stone rate and complication rate were compared between the two groups.Results The perioperative levels of all indexes in the observation group were better than those in the control group,the differences were statistically significant(P<0.05).There were no statistically significant differences in liver function indexes between the two groups before operation(P>0.05).The levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST)and direct bilirubin(DBil)in the observation group after operation were lower than those in the control group,with statistical significances(P<0.05).The rate of residual stone and the total incidence of complications in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05).Conclusion Anatomical hepatectomy based on Laennec membrane approach is effective in the treatment of patients with left intrahepatic cholelithiasis,with lower residual stone rate and fewer complications.The clinical application is safe and reliable,and worthy of promotion.