摘要
目的探讨腹腔镜经左纵沟人路解剖性左肝切除的可行性及临床效果。方法选择左肝内胆管结石患者103例．全麻下腹腔镜经左纵沟入路解剖性左肝外叶切除39例，左半肝切除20例．经左肝膈面入路左肝外叶切除29例，经第一肝门入路左半肝切除15例。结果103例行完全腹腔镜左肝切除，成功101例，2例中转开腹。101例中完全腹腔镜左肝外叶切除（Ⅱ、Ⅲ段）68例，经左纵沟组与经镰状韧带左侧肝膈面入路组相比，手术时间显著缩短（t=-2．723，P=0．008），术中出血量明显减少（t=-5．399，P=0．000），但在术后住院时间（t=-0．168，P=0．867）及术后并发症（χ2=0．664，P=0．415）2组差异无统计学意义。完全腹腔镜左半肝切除（Ⅱ、Ⅲ、Ⅳ段）33例，其中经左纵沟组与经第一肝门组相比，手术时间显著缩短（t=-3．144，P=0．004），2组术中出血量差异无统计学意义（t=-1．049，P=0．302），术后住院时间差异无统计学意义（t=0．784，P=0．439）。本组2例中转开腹。全组术后无大出血和顽固性胆漏（需再行手术干预者）及气体栓塞等并发症。术后1～4d肛门排气，平均（2．5±1．2）d，术后5～17d痊愈出院，平均（9．98±2．98）d。完全腹腔镜左肝切除101例，随访96例，失访5例。随访3～52（32．6±5．7）个月，术后复查未发现肝内外胆管结石残留。经第一肝门组术后复查CT提示肝尾状叶萎缩1例。结论腹腔镜经左纵沟入路解剖性左肝切除具有创伤小、恢复快、治疗彻底、便于操作等优点，是一种安全、有效、微创的手术方式。
Objective To evaluate left liver anatomical resection via left vertical groove by laparoscope. Method Among 103 patients with left intrahepatic biliary calculi, 39 cases underwent left lateral hepatectomy, 20 cases did left liver anatomical resection via left vertical groove by laparoscope, 29 cases underwent left lateral hepatectomy via left liver diaphragmatic surface, 15 cases did left liver anatomical resection via the first porta. Result In the 103 cases of laparoscopic left liver anatomical resection, 101 cases were successful and two cases were conversed to open surgery. In the success group, total laparoscopic anatomical left lateral lobectomy was performed （ Ⅱ , Ⅲ section） in 68 cases. Compared with the approach via left liver falciform ligament diaphragmatic surface, the operatve time via left vertical groove was significantly shorter（ t = -2. 723 ,P = 0. 008, intraoperative blood loss was significantly smaller （ t = - 5. 399, P = 0. 000 ）, while the differences in postoperative hospital stay （ t = - 0. 168, P = 0. 867 ） and postoperative complications （χ2= 0. 664, P = 0. 415 ） were of no statistical significance between the 2 groups. In the 33 cases of left hemihepatectomy （ Ⅱ ,Ⅲ, Ⅳ section）, those performed via left vertical groove compared with through the first porta hepatic, used shorter operation time （ t = - 3. 144, P = 0. 004）, while blood loss was similar（ t = - 1. 049 ,P =0. 302）, as well as the length of hospital stay（ t =0. 784 ,P = 0. 439）. There was no postoperative bleeding and intractable bile leakage, nor postoperative air embolism. Flatus on an average of （ 2.5 ± 1.2 ） days. Patients were discharged from hospital 5 - 17 （ 9.98 ± 2. 98 ） days post-op. 96 cases were followed up in the 101 cases undergoing successful total laparoscopic left hemihepatectomy. The followed-up time were 3 - 52 （32. 6 ± 5.7 ） months. Postoperative review found no residue stone. One case in first porta hepatis group, caudate lobe atrophy was found by p
出处
《中华普通外科杂志》
CSCD
北大核心
2015年第7期520-524,共5页
Chinese Journal of General Surgery
