左肝蒂阻断行腹腔镜左半肝切除术治疗肝内胆管结石疗效研究梁鑫张学军摘要：目的探讨腹腔镜左肝蒂阻断左半肝切除术治疗肝内胆管结石患者的疗效。方法回顾性分析2016年10月～2018年3月在承德医学院附属医院肝胆外科行手术治疗的67例肝内胆管结石患者的临床资料，其中35例行左肝蒂阻断腹腔镜左半肝切除术治疗设为腔镜组，32例行传统开腹左半肝切除术治疗设为开腹组，比较两组的手术时间、术中出血量、术后镇痛时间、胃肠恢复时间、术后住院时间、住院费用、术后并发症和术后第7天的白蛋白（ALB）、总胆红素（TBIL）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）变化情况。结果腔镜组手术时间较开腹组长[（269.11±54.43）minvs（211.72±31.64）min]，术后疼痛缓解时间[（2.89±1.41）dvs（4.81±1.58）d]，术后排气时间[（24.80±6.31）hvs（45.13±9.80）h]，术后住院时间[（9.51±2.38）dvs（14.19±2.86）d]均优于开腹组，差异均具有统计学意义（P0.05）;治疗后两组肝功能指标比较，差异无统计学意义（P>0.05）。结论腹腔镜下左肝蒂阻断左半肝切除术治疗肝内胆管结石的疗效与安全性是肯定的，与以往开腹肝切除术相比，腹腔镜左肝蒂阻断左半肝切除术创伤更小，并发症更少，术后恢复更快。关键词：肝内胆管结石;左肝蒂阻断;腹腔镜;肝切除术：R657.3文獻标识码：ADOI：10.3969/j.issn.1006-1959.2019.01.029：1006-1959（2019）01-0095-04TherapeuticEffectofLeftHepaticPedicleBlockadeonLaparoscopicLeftHepatectomyforIntrahepaticBileDuctStonesLIANGXin，ZHANGXue-jun（DepartmentofHepatobiliarySurgery，AffiliatedHospitalofChengdeMedicalCollege，Chengde067000，Hebei，China）Abstract：ObjectiveToinvestigatetheefficacyoflaparoscopiclefthepaticpedicleblockadeforlefthepatectomyinpatientswithintrahepaticbileductstones.MethodsTheclinicaldataof67patientswithintrahepaticbileductstoneswhounderwentsurgicaltreatmentofhepatobiliarysurgeryintheAffiliatedHospitalofChengdeMedicalCollegefromOctober2016toMarch2018wereretrospectivelyanalyzed.35patientsunderwentlefthepaticpedicleobstructionoflaparoscopiclefthepaticliver.Theresectionwasperformedinthelaparoscopicgroup，and32patientsunderwentconventionalopenlefthepatectomy.Theoperationtime，intraoperativebloodloss，postoperativeanalgesiatime，gastrointestinalrecoverytime，Postoperativehospitalstay，hospitalizationcosts，postoperativecomplications，andalbumin（ALB），totalbilirubin（TBIL），alanineaminotransferase（ALT），andaspartateaminotransferaseonday7postoperatively（AST）changes.ResultsTheoperationtimeofthelaparoscopicgroupwaslongerthanthatoftheopengroup[（269.11±54.43）minvs（211.72±31.64）min]，postoperativepainrelieftime[（2.89±1.41）dvs（4.81±1.58）d]，postoperativerowGastime[（24.80±6.31）hvs（45.13±9.80）h]，postoperativehospitalstay[（9.51±2.38）dvs（14.19±2.86）d]wasbetterthanopengroup，thedifferencewasstatisticallysignificant.（P<0.05）;Therewasnosignificantdifferenceintheamountofsurgicalbleeding，complicationsandtotalhospitalizationbetweenthetwogroups（P>0.05）.Therewasnosignificantdifferenceinliverfunctionbetweenthetwogroupsaftertreatment（P>0.05）.ConclusionTheefficacyandsafetyoflaparoscopiclefthepaticpedicleblockadeforlefthepatectomyinthetreatmentofintrahepaticbileductstonesispositive.Comparedwithpreviousopenliverresection，laparoscopiclefthepaticpedicleblocklefthepatectomyLesstrauma，fewercomplications，andfasterrecoveryaftersurgery.Keywords：Intrahepaticbileductstones;Lefthepaticpedicleblock;Laparoscopic;Hepatectomy肝内胆管结石（hepatolithiasis）复发率高，并发症多且难以根治，已成为肝胆外科的“难治性疾病”，也是我国良性...