全程显露肝中静脉的精准半肝切除治疗区域性肝胆管结石临床疗效与经验

目的探讨严格以肝中静脉为引导的精准性半肝切除治疗区域性肝胆管结石的临床疗效与经验。方法回顾性分析香港大学深圳医院肝胆胰外科2015年7月至2019年7月采用半肝切除术治疗区域性肝胆管结石47例患者资料,其中男性15例,女性32例,年龄(42±15)岁。全程显露并保留肝中静脉纳入精准手术组(n=26),未能全程显露肝中静脉或者损伤肝中静脉纳入对照组(n=21)。对比两组患者的手术时间、术中出血量等手术资料以及术后并发症等情况。结果所有患者均顺利完成手术,术后无肝衰竭患者,术后90 d无死亡患者。精准手术组的手术时间(5.2±1.8)h、术中出血量(620.5±450.8)ml,与对照组手术时间(4.9±2.3)h、术中出血量(760.5±540.2)ml比较差异无统计学意义(P>0.05)。共有19例(40.4%)患者(精准手术组7例,对照组12例)出现各类并发症36次,术后并发症发生率对照组多于精准手术组47.6%(10/21)比19.2%(5/26)],差异具有统计学意义(P<0.05)。47例患者均获得随访,随访时间6~30个月。术后远期并发症对照组5例患者分别出现残留结石、胆道感染、肝脓肿及胆肠吻合吻合口狭窄伴结石复发,精准手术组仅2例分别发现残留结石及胆肠吻合吻合口狭窄伴结石复发,远期并发症发生率对照组多于精准手术组23.8%(5/21)比7.7%(2/26)],差异具有统计学意义(P<0.05)。结论严格以肝中静脉为引导的精准性半肝切除治疗区域性肝胆管结石,能够较为彻底去除结石和病灶,降低复发率及术后并发症。

Effectiveness of anatomical hemi-hepatectomy strictly guided by the middle hepatic vein to treat regional intrahepatic hepatolithiasis

Objective To study the effiacious based on our experience of precise anatomical hemi-hepatectomy strictly guided by the middle hepatic vein(MHV)for regional to treat intrahepatic hepatolithiasis.Methods A retrospective analysis was conducted on the data of 47 patients with regional hepatolithiasis treated with hemihepatectomy from July 2015 to July 2019 at the Department of Hepatobiliary and Pancreatic Surgery,The University of Hong Kong-Shenzhen Hospital.The study included 15 males and 32 females,aged(42±15)years.The exposure and preservation of the MHV was included in the precision surgery group(n=26),and failure to fully expose the MHV or damage to the MHV was included in the control group(n=21).The operation time,intraoperative blood loss and other surgical data and postoperative complications of the two groups were compared.Results All patients successfully completed the operation.There was no patient who developed liver failure,and no patient died 90 days after the operations.The operation time(5.2±1.8)h and intraoperative blood loss(620.5±450.8)ml of the precision surgery group were not significantly different from those of the control group(4.9±2.3)h and intraoperative blood loss(760.5±540.2)ml(P>0.05).A total of 19 patients(40.4%)(7 in the precision surgery group and 12 in the control group)developed 36 post operative complications of various types.The postoperative complication rate in the control group was higher than that in the precision surgery group47.6%(10/21)vs 19.2%(5/26)],the difference was significant(P<0.05).All 47 patients were followed-up for 6 to 30 months.For postoperative long-term complications:5 patients in the control group had residual stones,biliary tract infection,liver abscess,and biliary-enteric anastomosis stenosis with recurrence of stones,and only 2 patients in the precision surgery group were found to have residual stones and biliary-enteric anastomotic stenosis.Stone recurrence,(the incidence of long-term complication)in the control group was significantly higher than that in the precision surgery group23.8%(5/21)vs 7.7%(2/26)],(P<0.05).Conclusions Precise anatomical hemi-hepatectomy strictly guided by MHV for regional hepatolithiasis could more fully remove stones and lesions,and reduced the rate of stone recurrence.It was safe and feasible with favorable efficacy.