腹腔镜肝切除术治疗左肝内胆管结石的临床应用

目的 探讨腹腔镜肝切除术治疗左肝内胆管结石的技术与疗效。 方法 回顾性分析2011年1月至2016年12月完成67例腹腔镜肝切除术治疗左肝内胆管结石临床及随访资料。 结果 全部67例患者合并左半肝或左外叶肝萎缩，腔镜手术方式包括左外叶肝切除48例、左半肝切除19例。其他腹腔镜下联合术式包括：胆囊切除术52例、胆总管探查术43例、T管引流术39例，胆总管一期修补术4例。手术切口长度（4.67±1.26）cm。术后发生胆漏3例，均经引流观察后自愈；1例因术后腹腔大出血合并胆瘘再手术治愈；肝脓肿1例，膈下脓肿1例，均经穿刺引流治愈。 结论 腹腔镜肝切除术治疗左肝内胆管结石安全可靠，术中应尽量取净其他胆道残余结石并连续紧密缝合左肝管残端。如结石已被取净胆总管的探查和T管引流并非必需。

Clinical application of laparoscopic hepatectomy for left hepatolithiasis

Objective To investigate the technique and curative effect of laparoscopic hepatectomy for left hepatolithiasis. Methods Clinical data of 67 patients with left hepatolithiasis who underwent laparoscopic hepatectomy from Jan. 2011 to Dec. 2016 were retrospectively analyzed. Results All the 67 patients were complicated with left hemihepatic or left lateral lobe atrophy. The laparoscopic surgery included 48 cases of left lateral liver lobe resection, 19 cases of left hemihepatic resection. Combined laparoscopic surgery was done: 52 cases of cholecystectomy, 43 cases of common bile duct exploration, 39 cases of T tube drainage, and 4 cases of primary common bile duct repair. The length of the surgical incision was (4.67±1.26) cm. Three cases of bile leakage occurred after operation, and all self-healed after drainage. One case with postoperative abdominal hemorrhage and biliary fistula was cured by reoperation. One case of liver abscess and one case of underarm abscess were cured by puncture drainage. Conclusion Laparoscopic hepatectomy is safe and reliable for the treatment of left intrahepatic bile duct stones. During the operation, the residual stones of the biliary tract should be removed as clearly as possible and the left hepatic biliary tract stump should be sutured continuously and tightly. If the stones have been removed completely, common bile duct exploration and the T tube drainage is not necessary.