【摘要】 目的探讨保留左肝管主干的前入路左半肝切除术在治疗左肝内胆管结石预防胆漏中的应用价值。方法回顾性分析泰州市人民医院2008年1月至2016年9月行左半肝切除术治疗的左肝内胆管结石患者75例,其中行保留左肝管主干的前入路左半肝切除术37例(前入路组),传统入路左半肝切除术38例(传统组),比较两组手术时间、术中失血量、住院天数及术后胆漏并发症的差异。结果所有病例均顺利完成手术。两组的性别、年龄、肝功能Child-Pugh分级的比较无统计学差异,前入路组较传统组手术时间短[(153.27±19.55)min vs(184.26±22.41)min,t=-6.38,P<0.01],术中出血量少[(109.78±18.41)m L vs(317.71±28.14)m L,t=-37.76,P<0.01],住院时间短[(10.16±0.65)d vs(15.39±1.03)d,t=-26.32,P<0.01],术后胆漏并发症例数少(1 vs 13,χ~2=12.26,P<0.01)。结论保留左肝管主干的前入路左半肝切除术可减少手术时间、术中失血量和住院时间,并显著减少术后胆漏发生率,在左半肝切除治疗左肝内胆管结石中值得推广。更多还原

【Abstract】 objective To evaluate the application value of approach of anterior left hemihepatectomy combined with preservation of the main trunk of left hepatic duct in the prevention of bile leakage. Methods A total of 75 patients with left hepatolithiasis who underwent left hemihepatectomy between Jan. 2008 and Sep. 2016 in Taizhou People’s Hospital were retrospectively analyzed. Among them, 37 patients underwent anterior approach of left hemihepatectomy combined with preservation of the main trunk of left hepatic duct(anterior approach group), and 38 patients underwent left hemihepatectomy via traditional approach(traditional approach group). The differences in operation duration, intraoperative blood loss, hospitalization duration and postoperative bile leakage were compared between two groups. Results All patients underwent surgeries successfully. There were no statistically significant differences in sex, age and grade of Child-Pugh liver function between the two groups, the patients in the anterior approach group had shorter operation duration [(153.27±19.55)min vs(184.26±22.41)min, t=-6.38, P<0.01], less intraoperative blood loss [(109.78±18.41)m L vs(317.71±28.14)m L, t=-37.76, P<0.01], shorter hospitalization duration [(10.16±0.65)d vs(15.39±1.03)d, t=-26.32, P<0.01] and fewer cases with postoperative bile leakage(1 vs 13, χ~2=12.26, P<0.01). Conclusion The approach of anterior left hemihepatectomy combined with preservation of the main trunk of left hepatic duct can reduce the operation duration, intraoperative blood loss and hospitalization duration, and significantly reduces the incidence of postoperative bile leakage, thus it is the preferred method for left hepatectomy treatment of hepatolithiasis and is of worthy of promotion.更多还原