关键词: 腹腔镜, 肝切除术, 结石症

Abstract:

Clinical efficacy of laparoscopic liver resection in treatment of recurrent hepatolithiasis in patients with history of multiple biliary tract surgery        LI Wei-nan, LI Qiang, XU Jian, et al.  Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical University; Hepatobiliary and Pancreatic Intestinal Institute, North Sichuan Medical University, Nanchong 637000, China
Corresponding author：LI Jing-dong, E-mail:lijingdong358@126.com
Abstract    Objective    To investigate the clinical efficacy of laparoscopic liver resection in treatment of recurrent hepatolithiasis in patients with history of multiple biliary tract surgery. Methods    The clinical data were collected from Affiliated Hospital of North Sichuan Medical University between May 2015 and May 2017. All patients had two or more history of biliary tract surgery. Results    Among the 12 cases, 8 cases received exploration of the bile duct+hepatic segmentectomy (lobectomy)+T-tube drainage, 2 case received exploration of the common bile duct+hepatic segmentectomy (lobectomy)+hilar bile duct plastic surgery, 2 cases received exploration of the common bile duct and choledochoscope through the bilioenteric anastomosis Roux-Y jejunal loop. The mean operation was 285(238—348) min and the intraoperative blood loss was 484(396—627) mL. Four patients were conducted blood transfusion treatment, and the blood transfusion amount about 356（200—800）mL. The portal triad clamping were used in the patients. In 12 patients, duodenal plasma muscular injury in 1 case, transverse muscular injury in 1 case, the transverse colon full-thickness injury in 1 case, stomach plasma muscular injury in 3 cases. The anal exhaust time was (1.6±0.8) d and the ostoperative hospital stay was (9.6±4.2) d in the 12 patients; 7 cases of postoperative complications, the area of effusion in 2 cases, abdominal cavity effusion in 3 cases, bleeding in 1 case, bile leakage in 2 cases, the residual stone in 3 cases (1 case of the area at the same time merge effusion and peritoneal effusion, 1 case with residual stone and bleeding, 1 case of merger and residual stone, 1 case of abdominal cavity effusion combined the art district effusion and bile leakage).All complications were cured by symptomatic improvement. There was no surgery patients in perioperative period. During the follow-up, it could be completely asymptomatic in 9 cases. Three cases had occasional mild cholangitis sometimes. The "T" tube indwelling off after 2 months in a case of residual stones patients, and put the catheter in sinus tract immediately. Three patients with residual stones were cured after remove residual stones with electron choledochoscope with 1 to 3 times. Conclusion    Based on evaluating patients’ condition sufficiently, the rich experience of laparoscopic hepatectomy and the experience of diagnosis and treatment of a variety of difficult condition in hepatolith disease, clinical curative effect is feasible and reliable in the recurrent hepatolith patients with the history of multiple biliary surgery to use laparoscopic liver resection.

Key words: laparoscope, hepatectomy, hepatolithiasis