摘要
目的探讨腹腔镜技术治疗复杂肝胆管结石病的难点与手术决策。方法回顾性收集2019年12月至2020年12月川北医学院附属医院肝胆外科收治的因复杂肝胆管结石病行腹腔镜下肝切除手术治疗的13例患者的临床资料。男性3例,女性10例,平均年龄50.8岁(范围:14~67岁)。所有患者均有上腹部疼痛表现,其中4例伴有发热。所有患者均有胆囊切除术史。行腹腔镜下左半肝切除+胆道探查术7例,腹腔镜下右半肝切除+胆道探查术2例,腹腔镜下肝方叶切除(肝脏4b段+部分5段)+肝门胆管整形+胆道探查术2例,腹腔镜下肝方叶切除(肝脏4b段+部分5段)+肝门胆管整形+重建胆肠吻合术2例。所有患者术后3个月复查腹部超声和胆道镜。结果本组13例患者平均手术时间为5.2 h(范围:3.6~6.5 h),平均出血量278 ml(范围:120~580 ml)。1例术中出现十二指肠球部损伤,缺损面积约1.0 cm×1.2 cm,及时发现后评估缺损面积,对损伤部位予以修剪,采用可吸收线横行间断缝合十二指肠球部,修补后行胃空肠吻合术;1例出现小肠浆膜层损伤,用可吸收线间断缝合包埋,术后恢复顺利。本组患者术后均顺利恢复,无死亡病例。术后3个月对患者进行腹部超声及经T管窦道胆道镜检查,其中3例患者发现胆道残留结石(2例在术后3个月行经T管窦道胆道镜取尽结石;1例患者因手术后未满3个月,处于恢复期未处理结石),余10例患者均无结石残留。结论充分掌握复杂肝管结石手术中的三项关键技术——粘连松解及肝门显露、腹腔镜肝切除术、腹腔镜下胆肠吻合口处理,是安全施行腹腔镜技术治疗复杂肝胆管结石的基础。
Objective To explore the difficulties and surgical decision of laparoscopic technique in patients with complicated hepatolithiasis.Methods The clinical data of 13 patients with complicated hepatolithiasis who underwent laparoscopic hepatectomy at Department of Hepatobiliary Surgery,Affiliated Hospital of North Sichuan Medical College from December 2019 to December 2020 were collected.There were 3 males and 10 females with average age of 50.8 years(range:14 to 67 years).All patients had upper abdominal pain and a history of cholecystectomy,4 of them had fever.Seven cases underwent laparoscopic left hemihepatectomy+bile duct exploration,2 cases underwent laparoscopic right hemihepatectomy+bile duct exploration,2 cases underwent laparoscopic quadrate hepatectomy(liver 4B+Part 5)+hilar cholangioplasty+bile duct exploration,2 cases underwent laparoscopic quadrate lobe resection(liver 4B+Part 5)+cholangioplasty+cholangiojejunostomy.All patients were re-examined with abdominal ultrasound and choledochoscope 3 months after operation.Results The median operation time was 5.2 hours(range:3.6-6.5 hours),blood loss was 278 ml(range:120-580 ml).During the operation,1 case had duodenal bulb injury,and the defect area was about 1.0 cm×1.2 cm.After timely detection,the defect area was carefully evaluated and trimmed.Absorbable suture was used to suture duodenal bulb,and gastrojejunostomy was performed after repair.One case had small intestinal serosa injury,which was intermittently sutured and embedded with absorbable suture.All the patients recovered smoothly without death.Three months after the operation,12 patients completed abdominal ultrasound and T-tube sinus choledochoscopy.Residual stones were found in 3 patients,stones were removed in 2 patients by T-tube sinus choledochoscopy 3 months after the operation,1 patient was still in the recovery period(within 3 months after surgery).No residual stones were found in the remaining 10 patients.Conclusion The three key laparoscopic techniques in operation of complex hepatolithi
作者
李伟男
熊永福
朱建交
杨刚
孙骥
李敬东
Li Weinan;Xiong Yongfu;Zhu Jianjiao;Yang Gang;Sun Ji;Li Jingdong(Department of Hepatobiliary Surgery,Affiliated Hospital of North Sichuan Medical College,Institute of Hepatobiliary-Pancreatic-Intestinal Diseases,North Sichuan Medical College,Nanchong 637000,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2021年第4期279-283,共5页
Chinese Journal of Surgery
关键词
腹腔镜
复杂肝胆管结石
手术难点
Laparoscopy
complicated hepatolithiasis
surgical difficulties
