本文選題：肝膽管結(jié)石 + 左肝內(nèi)膽管結(jié)石�。� 參考：《南昌大學(xué)》2017年碩士論文

【摘要】：目的:在特殊部位(影像學(xué)上結(jié)石位于門(mén)靜脈左支矢狀段和(或)肝左靜脈近端附近)的左肝內(nèi)膽管結(jié)石行腹腔鏡下左外葉切除和腹腔鏡下左半肝切除的療效對(duì)比研究。方法:回顧性分析2011年01月至2016年01月在南昌大學(xué)第二附屬醫(yī)院因特殊部位左肝內(nèi)膽管結(jié)石進(jìn)行手術(shù)的60例患者的臨床資料,其中將29例行腹腔鏡左外葉切除術(shù)患者設(shè)置為左外葉切除組。將31例行腹腔鏡下左半肝切除術(shù)的患者設(shè)置為左半肝切除組。對(duì)左外葉切除組與左半肝切除組的術(shù)后并發(fā)癥、術(shù)后結(jié)石殘留率、復(fù)發(fā)率和術(shù)后的療效進(jìn)行比較。結(jié)果:兩組術(shù)前肝功能均為Child-Plug A級(jí),ICG R1510%,兩種手術(shù)方式術(shù)中均應(yīng)用了內(nèi)鏡切割閉合器去處理左肝靜脈及部分肝實(shí)質(zhì)。左半肝切除組與左外葉切除組比較術(shù)中出血量(P=0.023)與手術(shù)時(shí)間(P=0.040),兩項(xiàng)數(shù)據(jù)均左半肝組高于左外葉組。左外葉組結(jié)石復(fù)發(fā)率13.8%,左半肝結(jié)石復(fù)發(fā)率0%。左外葉切除組術(shù)后結(jié)石殘留率為17.2%,左半肝切除組則為0%。左外葉切除組術(shù)后總并發(fā)癥發(fā)生率27.5%,而左半肝切除者術(shù)后總并發(fā)癥發(fā)生率是29%。左半肝切除組與左外葉切除組的遠(yuǎn)期療效為93.3%和73.3%。結(jié)論:對(duì)于影像學(xué)上位于門(mén)靜脈左支矢狀段和(或)肝左靜脈近端附近這類(lèi)交界性區(qū)域的左肝膽管結(jié)石,行腹腔鏡左半肝切除是目前更有效、更徹底的治療方法。
[Abstract]:Objective: to compare the effects of laparoscopic left lateral lobe resection and laparoscopic left hemihepatectomy on left intrahepatic cholelithiasis located near the sagittal segment of the left portal vein and / or the proximal end of the left hepatic vein in the special site (radiographically located in the sagittal segment of the left portal vein and / or the proximal end of the left hepatic vein). Methods: the clinical data of 60 patients with left intrahepatic cholelithiasis in the second affiliated Hospital of Nanchang University from January 2011 to January 2016 were retrospectively analyzed. Among them, 29 patients with laparoscopic left lateral lobectomy were assigned to left lateral lobectomy group. Thirty-one patients undergoing laparoscopic left hemihepatectomy were assigned to the left hemihepatectomy group. The postoperative complications, residual stone rate, recurrence rate and postoperative efficacy were compared between left lateral lobectomy group and left hemihepatectomy group. Results: the liver function of the two groups was Child-Plug A grade and ICG R15100.The left hepatic vein and some hepatic parenchyma were treated with endoscopic dissecting occluder. The volume of intraoperative bleeding and the time of operation were compared between the left hemihepatectomy group and the left lateral lobectomy group. The two data were higher in the left half liver group than in the left lateral lobe group. The recurrence rate of stones in left lateral lobe group was 13. 8%, and that in left half liver stone group was 0. The residual rate of stones was 17.2 in left lateral lobectomy group and 0 in left hemihepatectomy group. The incidence of postoperative complications in the left lateral lobectomy group was 27.5 and that in the left hemihepatectomy group was 29. The long-term results of left hemihepatectomy group and left lateral lobectomy group were 93. 3% and 73. 3% respectively. Conclusion: laparoscopic left hemihepatectomy is a more effective and thorough method for the left hepatolithiasis located near the sagittal segment of the left portal vein and / or the proximal end of the left hepatic vein.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R657.3

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