摘要
目的探讨腹腔镜经右横沟、右切迹入路鞘内解剖性右半肝切除治疗右肝良性疾病的疗效。方法选择右半肝良性病变患者32例（肝血管瘤7例，肝局灶性结节性增生2例，右肝内胆管结石23例，其中19例合并肝外胆管结石）。腹腔镜经右横沟、右切迹入路鞘内解剖性右半肝切除，合并肝外胆管结石患者联合胆道镜胆管探查和取石。结果28例患者成功完成腔镜下经右横沟、右切迹入路鞘内解剖性右半肝切除，中转开腹4例。手术时间235-405min，右半肝切除时间平均（305±41）min，右半肝切除联合胆道镜胆管探查和取石者平均（326±48）min。术中出血平均（573±219）ml。术后复查肝血管瘤和局灶性结节性增生患者病灶无残留。肝内胆管结石患者，结石残留2例，通过再次胆道镜取尽，结石一次清除率为91．3％（21／23）。术后胆漏发生3例，胸腔积液7例。均通过引流痊愈。术后平均（2．8±0．71）d肛门排气，胃肠功能恢复进食；术后平均住院日（11．5±2．98）d。术后28例获随访，失访3例，随访率89．3％（25／28），平均随访（32±8）个月，肝血管瘤和局灶性结节性增生患者无复发，结石再发2例，复发率8．6％（3／23）。结论腹腔镜经右横沟、右切迹入路鞘内解剖性右半肝切除治疗右肝良性疾病的手术方式疗效满意。
Objective To evaluate laparoscopic right hepatectomy through the right incisura or the fight groove for hepatic benign disease. Methods This study enrolled 32 patients of hepatic benign lesions within the right lobe of the liver including hepatic hemangioma （ n = 7 ）, hepatic focal nodular hyperplasia （n = 2 ）, fight intra-hepatic bile duct stones （n = 23 ） with concomitant extra-hepatic bile duct stones in 19 eases. Results Laparoseopie procedures were successful in 28 patients, while 4 patients were converted to laparotomy. Time of operation was 235 to 405 min, time for fight hemihepatectomy was （305±41 ） min on average. Time for fight hemihepateetomy and biliary tract exploration and removal of stones was （ 326 ± 48 ） min on average. The intraoperative blood loss was （573 ±219） ml on average. On postoperative follow-up, patients with hepatic hemangioma and focal nodular hyperplasia had no residual lesions. 2 cases suffered calculus residue, residual stones were removed by repeat choledochoscopy with primary stones clearence rate of 91.3% （21/23）. Bile leakage occurred in 3 cases and pleural effusion in 7 cases. The gastrointestinal function recovered （2. 8 ±0. 71 ） days after surgery. The hospital stay was （11.5 ±2. 98） days. 28 patients were followed up for （ 32 ± 8 ） months. Conclusion The laparoscopic anatomical fight hemihepateetomy through the right ineisura or the fight groove is a satisfactory surgical procedure.
作者
刘天锡
关斌颖
方登华
杨国际
熊见武
王星入
Liu Tianxi;Guan Binying;Fang Denghua;Yang Guofi;Xiong Jianwu;Wang Xingru(Department of Hepatobiliary Surgery,the Second People＇s Hospital of Qujing City,Qujing 655000,China)
出处
《中华普通外科杂志》
CSCD
北大核心
2018年第8期675-677,共3页
Chinese Journal of General Surgery
关键词
肝切除术
腹腔镜
肝脏良性疾病
Hepatectomy
Laparoscopes
Liver benign diseases
