Glisson蒂两步横断式腹腔镜解剖性左半肝切除术治疗肝内胆管结石的临床疗效

Clinical efficacy of laparoscopic anatomical left hepatectomy with two‑step Glisson′s pedicle transection for intrahepatic biliary stone

    摘要
  • 摘要:
    目的 探讨Glisson蒂两步横断式腹腔镜解剖性左半肝切除术治疗肝内胆管结石的临床疗效。
    方法 采用回顾性描述性研究方法。收集2018年10月至2025年9月湖南省人民医院收治的68例行Glisson蒂两步横断式腹腔镜解剖性左半肝切除术治疗肝内胆管结石患者的临床病理资料；男27例,女41例；年龄为58（31~77）岁。68例患者肝内胆管结石均位于左半肝。观察指标：（1）术中情况。（2）术后情况。（3）术后病理学检查情况。（4）随访情况。偏态分布的计量资料以M（范围）或M（Q1,Q3）表示；计数资料以绝对数和（或）百分比表示。
    结果 （1）术中情况：68例患者术中均行胆道镜检查,其中2例因既往手术导致腹腔内致密粘连中转开腹手术。66例完成Glisson蒂两步横断式腹腔镜解剖性左半肝切除术。患者术中第一肝门阻断时间为55.5（19.0~126.0）min,手术时间为297.5（180.0~513.0）min；术中出血量为100（30~600）mL,2例患者术中输血。（2）术后情况：66例患者术后第1天总胆红素为18.60（3.49,83.03）μmol/L、丙氨酸转氨酶为147.45（50.80,634.30）U/L、天冬氨酸转氨酶为171.85（22.60,1 169.30）U/L,术后第3天上述指标分别为17.20（5.40,111.73）μmol/L、80.65（13.90,574.30）U/L、41.20（17.89,477.80）U/L。66例患者中,4例术后CT和（或）磁共振胰胆管造影检查结果提示结石残留,其中3例胆总管内残留结石通过术后胆道镜或消化内镜取尽,1例肝S8背侧段末梢胆管内残留结石无法取出；结石最终清除率为98.5%（65/66）。所有患者术后未进行二次手术。66例患者术后并发症发生率为18.2%（12/66）,其中Clavien⁃Dindo Ⅱ级并发症11例,Ⅲa级并发症1例；术后住院时间为10.5（6.0~23.0）d。（3）术后病理学检查情况：66例患者术后病理学检查结果提示肝内胆管结石,炎性改变；51例患者胆管伴不典型增生。（4）随访情况：66例患者均获得随访,随访时间为28（3~72）个月,其中3例胆管结石复发。
    结论 Glisson蒂两步横断式腹腔镜解剖性左半肝切除术治疗左半肝肝内胆管结石安全、可行。

     

    Abstract:
    Objective To investigate the clinical efficacy of laparoscopic anatomical left hepatectomy with two‑step Glisson′s pedicle transection for intrahepatic biliary stone.
    Methods The retrospective and descriptive study was conducted. The clinicopathological data of 68 patients who underwent laparoscopic anatomical left hepatectomy with two‑step Glisson′s pedicle transection for intrahepatic biliary stone at Hunan Provincial People′s Hospital from October 2018 to September 2025 were collected. There were 27 males and 41 females, aged 58(range, 31-77) years. All 68 patients had intrahepatic biliary stone located at left lobe. Observation indicators: (1) intraoperative conditions; (2) postoperative conditions; (3) postoperative pathological examination; (4) Follow‑up. Measurement data with skewed distribution were expressed as M(range) or M(Q1,Q3), and count data were expressed as absolute numbers/percentages.
    Results (1) Intraoperative conditions: all 68 patients underwent choledochoscopy during the operation, among which 2 cases were converted to open surgery due to dense adhesion in the abdominal cavity caused by previous surgeries. Of the 66 cases undergoing laparoscopic anatomical left hepatectomy with two‑step Glisson′s pedicle transection, the duration of first porta hepatis block during the operation was 55.5(range, 19.0-126.0) minutes, operation time was 297.5(range, 180.0-513.0) minutes, the volume of intraoperative blood loss was 100(range, 30-600) mL, respectively. Two cases received intraoperative blood transfusion. (2) Postoperative conditions: on the first postoperative day, the total bilirubin level of the 66 patients was 18.60(3.49, 83.03) μmol/L, the alanine aminotransferase was 147.45(50.80, 634.30) U/L, and the aspartate aminotransferase was 171.85(22.60, 1 169.30) U/L. On the third postoperative day, the above indicators were 17.20(5.40, 111.73) μmol/L, 80.65(13.90, 574.30) U/L, and 41.20(17.89, 477.80) U/L, respectively. Of the 66 patients, 4 cases showed residual stones on postoperative computed tomography/magnetic resonance cholangiopancreatography. Among them, 3 cases had residual stones in the common bile duct that were removed completely through postoperative choledochoscopy or digestive endoscopy, while 1 case had residual stones in the peripheral bile duct of the dorsal subsegment of liver S8 that could not be removed. The final clearance rate of stones was 98.5%(65/66). None of patient underwent secondary surgery after operation. The incidence of postoperative complications in 66 patients was 18.2%(12/66), including 11 cases of Clavien‑Dindo grade Ⅱ complications and 1 case of grade Ⅲa complications. The duration of postoperative hospital stay was 10.5(range, 6.0-23.0) days. (3) Postoperative pathological examination: results of postoperative pathological examination for the 66 patients indicated intrahepatic biliary stones with inflammatory changes, among which 51 patients had bile duct with atypical hyperplasia. (4) Follow‑up: all 66 patients were followed up for 28 (range, 3-72) months. Three patients experienced recurrence of bile duct stones.
    Conclusion Laparoscopic anatomical left hepatectomy with two‑step Glisson′s pedicle transection for intrahepatic biliary stone in left lobe is safe and feasible.

     

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