本站原创[摘 要 ] 目的 探讨腹腔镜下解剖性左半肝切除治疗肝内胆管结石的临床效果. 方法 选择手术治疗的肝内胆管结石患者54例,分为腹腔镜组和开腹组,比较两组术中、术后情况. 结果 两组手术时间差异无统计学意义（P > 0.05）.两组术中出血量、拔除引流管的时间、术后使用镇痛药物的时间、术后住院时间比较差异有统计学意义（P < 0.01或P < 0.05）,两组并发症例数比较,差异无统计学意义（P > 0.05）. 结论 腹腔镜下左半肝切除治疗肝内胆管结石能够减少术中出血量、缩短拔除引流管的时间和术后使用镇痛药的时间,且不增加并发症的发生.
[关 键 词 ] 腹腔镜；肝内胆管结石；Child分级
[中图分类号] R657.4 [文献标识码] B [文章编号] 1673-9701（2012）30-0045-02
Curative effect observation of laparoscopic left semihepatectomy for the treatment of hepatolithiasis
KUANG Haineng LIU Qifei ZHAGN Weiju
Department of Surgery, Hanguang Hospital of Yingde City in Guangdong Province, Yingde 513036, China
[Abstract] Objective To discuss the efficacy of laparoscopic left semihepatectomy for the treatment of hepatolithiasis. Methods Selected 54 cases with hepatolithiasis were devided into laparoscopic group and open group.Intraoperative and postoperation were pared between two groups. Results The operating time of two groups had no significant difference（P > 0.05）. Peri-operative bleeding of laparoscopic group was less than open group, the time of decannulation and using of analgesic drug in laparoscopic group were shorter than open group,the postoperative hospitalization time in laparoscopic group was also shorter than open group （P < 0.01 or P < 0.05）. Complications of two groups had no significant difference（P > 0.05）. Conclusion Laparoscopic left semihepatectomy for the treatment of hepatolithiasis shows less Peri-operative bleeding, can shorten the time of decannulation and using of analgesic drug, and no increase plications.
[Key words] Laparoscopic；Hepatolithiasis；Child classification
肝内胆管结石以肝脏左叶和右后叶为多发[1],肝叶规则切除是治疗肝内胆管结石的有效方法之一[2].1991年即有报道采用腹腔镜进行肝叶切除的报道.随着腹腔镜仪器的改进,腹腔镜在肝内胆管结石肝叶切除术中的应用也逐渐在临床上得到推广.本文总结腹腔镜手术治疗的27例肝内胆管结石患者的临床效果,现报道如下.
1.资料与方法
1.1 一般资料
选择2011年6月～2012年2月在来我院手术治疗的肝内胆管结石的患者54例,其中男30例,女24例,年龄37～46岁,平均（41.8±8.6）岁.排除合并有梗阻性化脓性胆管炎,术前评估不能耐受手术,合并有其他肝段严重结石者.随机分为腹腔镜组29例,开腹组25例,两组一般资料比较差异无统计学意义（P > 0.05）,具有可比性.见表1.
1.2 手术方法
1.2.1 腹腔镜组 麻醉成功后,脐下缘行长约1 cm的切口,建立气腹,压力维持约14 mmHg,置入腹腔镜,右侧腋中线直视下插入两个5 mm trocar,左侧肋缘下直视插入12 mm trocar,置入操作器械.使用彭氏多功能手术刀分离肝脏周围的粘连、左三角韧带、肝镰状韧带、左冠状韧带、肝胃韧带等,游离肝脏至左冠状韧带的起始位置.根据肝脏的粘连情况采用不同的肝血流阻断方法.使用彭氏刀切肝断肝.肝叶切除后取出,创面进行冲洗止血.术中对左肝管残端活胆囊管残端进行胆道镜或造影检查.术后排出CO2,缝合切口.
1.2.2 开腹组 麻醉成功后,切开皮肤及皮下组织,暴露肝脏,分离粘连、分离肝左叶后,阻断血管,常规切除肝叶,完成手术后按顺序关腹.
1.3 观察指标