胆道镜辅助Glission蒂横断法在腹腔镜左半肝切除治疗左肝内胆管结石的应用

Application of choledochoscope assisted Glission pedicle transection in laparoscopic left hepatectomy for left intrahepatic bile duct stones

摘要:

目的： 探讨腹腔镜下胆道镜辅助Glisson蒂法解剖性左半肝切除治疗左肝内胆管结石的可行性。方法： 回顾性分析2016年12月至2020年2月中国人民解放军西部战区总医院全军普外中心采用腹腔镜下胆道镜辅助Glisson蒂法解剖性左半肝切除处置的10例左肝内胆管结石患者的临床资料。结果： 10例患者中男性4 例，女性6 例；年龄45~68 岁；10例患者均手术成功，手术时间245（200，320） min，术中出血300（200，650） mL，术中左肝蒂在胆道镜引导下采用一次性切割吻合器离断，离断位置良好，无一例出现保留侧胆管损伤，无一例出现大出血和胆漏；无一例出现中转开腹；术后不良事件轻微，1例患者出现轻微漏胆，1例出现少量胸腔积液，Clavien-Dindo并发症分级均为Ⅱ级，经保守治疗后痊愈；恢复流质饮食时间90~102 h，术后住院时间8~13 d，住院费用为（4.02±0.36）万元。结论： 腹腔镜下胆道镜辅助Glisson蒂法解剖性左半肝切除治疗左肝内胆管结石在器械、技术保障下是安全、可行的，且不会增加患者住院费用。

Abstract:

Objective: To investigate the feasibility of choledochoscope assisted Glisson pedicle transection in laparoscopic left hepatectomy for left intrahepatic bile duct stones. Methods: The clinical data of 10 patients with left intrahepatic bile duct stones treated by laparoscopic choledochoscopy assisted Glisson pedicle anatomical left hepatectomy in the General Surgery Center of the PLA Western Theater General Hospital from December 2016 to February 2020 were retrospectively analyzed. Results: Among the 10 patients，there were 4 males and 6 females，aged 45-68. The operation was successful among all the 10 patients. The operation time was 245（200，320） min，and the intraoperative blood loss was 300（200，650） mL. During the operation，the left hepatic pedicle was cut off with a disposable cutting stapler under the guidance of choledochoscope，and the position of the cut-off was good，without injury of the reserved bile duct，no massive hemorrhage and bile leakage，no conversion to laparotomy. And the postoperative adverse events were mild，including slight bile leakage in 1 patient and a small amount of pleural effusion in 1 patient. The Clavien-Dindo complication grade was Ⅱ，which was treated conservatively. The recovery time of liquid diet was 90-102 h，the postoperative hospital stay was 8-13 d，and the cost of hospitalization was（4.02 ± 0.36） ten thousand yuan. Conclusion: The application of choledochoscope assisted with Glisson pedicle transection in the treatment of left hepatolithiasis by laparoscopic left hepatectomy is safe and feasible under the protection of instruments and techniques，and it will not increase the hospitalization expenses of patients.