腹腔镜左半肝切除在特殊部位的左肝胆管结石中的应用价值

发布时间：2018-05-27 10:43

本文选题：肝胆管结石 + 左肝内胆管结石　；参考：《南昌大学》2017年硕士论文

【摘要】：目的:在特殊部位(影像学上结石位于门静脉左支矢状段和(或)肝左静脉近端附近)的左肝内胆管结石行腹腔镜下左外叶切除和腹腔镜下左半肝切除的疗效对比研究。方法:回顾性分析2011年01月至2016年01月在南昌大学第二附属医院因特殊部位左肝内胆管结石进行手术的60例患者的临床资料,其中将29例行腹腔镜左外叶切除术患者设置为左外叶切除组。将31例行腹腔镜下左半肝切除术的患者设置为左半肝切除组。对左外叶切除组与左半肝切除组的术后并发症、术后结石残留率、复发率和术后的疗效进行比较。结果:两组术前肝功能均为Child-Plug A级,ICG R1510%,两种手术方式术中均应用了内镜切割闭合器去处理左肝静脉及部分肝实质。左半肝切除组与左外叶切除组比较术中出血量(P=0.023)与手术时间(P=0.040),两项数据均左半肝组高于左外叶组。左外叶组结石复发率13.8%,左半肝结石复发率0%。左外叶切除组术后结石残留率为17.2%,左半肝切除组则为0%。左外叶切除组术后总并发症发生率27.5%,而左半肝切除者术后总并发症发生率是29%。左半肝切除组与左外叶切除组的远期疗效为93.3%和73.3%。结论:对于影像学上位于门静脉左支矢状段和(或)肝左静脉近端附近这类交界性区域的左肝胆管结石,行腹腔镜左半肝切除是目前更有效、更彻底的治疗方法。
[Abstract]:Objective: to compare the effects of laparoscopic left lateral lobe resection and laparoscopic left hemihepatectomy on left intrahepatic cholelithiasis located near the sagittal segment of the left portal vein and / or the proximal end of the left hepatic vein in the special site (radiographically located in the sagittal segment of the left portal vein and / or the proximal end of the left hepatic vein). Methods: the clinical data of 60 patients with left intrahepatic cholelithiasis in the second affiliated Hospital of Nanchang University from January 2011 to January 2016 were retrospectively analyzed. Among them, 29 patients with laparoscopic left lateral lobectomy were assigned to left lateral lobectomy group. Thirty-one patients undergoing laparoscopic left hemihepatectomy were assigned to the left hemihepatectomy group. The postoperative complications, residual stone rate, recurrence rate and postoperative efficacy were compared between left lateral lobectomy group and left hemihepatectomy group. Results: the liver function of the two groups was Child-Plug A grade and ICG R15100.The left hepatic vein and some hepatic parenchyma were treated with endoscopic dissecting occluder. The volume of intraoperative bleeding and the time of operation were compared between the left hemihepatectomy group and the left lateral lobectomy group. The two data were higher in the left half liver group than in the left lateral lobe group. The recurrence rate of stones in left lateral lobe group was 13. 8%, and that in left half liver stone group was 0. The residual rate of stones was 17.2 in left lateral lobectomy group and 0 in left hemihepatectomy group. The incidence of postoperative complications in the left lateral lobectomy group was 27.5 and that in the left hemihepatectomy group was 29. The long-term results of left hemihepatectomy group and left lateral lobectomy group were 93. 3% and 73. 3% respectively. Conclusion: laparoscopic left hemihepatectomy is a more effective and thorough method for the left hepatolithiasis located near the sagittal segment of the left portal vein and / or the proximal end of the left hepatic vein.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.3

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