背景:本研究旨在探讨肝中静脉(MHV)引导下腹腔镜解剖左半肝切除术治疗有上腹部手术史的肝胆管结石患者的安全性和有效性。
方法:回顾性分析2018年1月至2022年4月在南昌大学第二附属医院行腹腔镜左肝切除术治疗肝胆管结石并上腹部手术的患者资料。根据手术方式的不同,患者分为由MHV组引导的腹腔镜解剖左肝切除术(MHV-AH组)和由MHV组引导的腹腔镜传统解剖左肝切除术(非MHV-AH组).
结果:本研究包括81名患者,MHV-AH和非MHV-AH组中有37例和44例患者,分别。两组的基本资料无明显差别。5例中转开腹,其余均在腹腔镜下顺利完成。与非MHV-AH组相比,MHV-AH组手术时间稍长(319.30minvs273.93min,P=0.032),较低的胆漏率(5.4%vs20.5%,P=0.047),结石残留率(2.7%对20.5%,P=0.015),结石复发率(5.4%vs22.7%,P=0.028),和胆管炎复发率(2.7%vs22.7%,P=0.008)。其他观察指标结果组间差异无统计学意义。
结论:MHV引导下腹腔镜解剖左肝切除治疗有上腹部手术史的左肝胆管结石安全有效。它不会增加术中出血,并降低术后胆漏的风险,残留的石头,结石复发,和胆管炎复发。
This study aimed to investigate the safety and efficacy of laparoscopic anatomical left hemihepatectomy guided by the middle hepatic vein (MHV) for the treatment of patients with hepatolithiasis who had a history of upper abdominal surgery.
Retrospective data analysis was performed on patients who underwent laparoscopic left hepatectomy for hepatolithiasis and with previous upper abdominal surgery at the Second Affiliated Hospital of Nanchang University from January 2018 to April 2022. According to the different surgical approaches, patients were divided into laparoscopic anatomical left hepatectomy guided by the MHV group (MHV-AH group) and laparoscopic traditional anatomical left hepatectomy not guided by the MHV group (non-MHV-AH group).
This study included 81 patients, with 37 and 44 patients in the MHV-AH and non-MHV-AH groups, respectively. There was no significant difference in the basic information between the two groups. Five cases were converted to laparotomy, and the remaining were successfully completed under laparoscopy. Compared to the non-MHV-AH group, the MHV-AH group had a slightly longer operation time (319.30 min vs 273.93 min, P = 0.032), lower bile leakage rate (5.4% vs 20.5%, P = 0.047), stone residual rate (2.7% vs 20.5%, P = 0.015), stone recurrence rate (5.4% vs 22.7%, P = 0.028), and cholangitis recurrence rate (2.7% vs 22.7%, P = 0.008).There were no significant differences in the results of other observation indices between the groups.
Laparoscopic anatomical left hepatectomy guided by the MHV is safe and effective in the treatment of left hepatolithiasis with a history of upper abdominal surgery. It does not increase intraoperative bleeding and reduces the risk of postoperative bile leakage, residual stones, stone recurrence, and cholangitis recurrence.