探讨腹腔镜下解剖性肝切除术治疗肝内胆管结石的安全性及可行性。

本回顾性研究对象为2008年3月至2012年3月中南大学湘雅三医院肝胆外科收治的35例肝内胆管结石患者，术前行超声、计算机断层摄影术（CT）或磁共振胰胆管成像（MRCP）明确肝内胆管结石的部位、肝脏萎缩及肝硬化情况，在腹腔镜下行解剖性肝切除术。所有患者均签署知情同意书，符合医学伦理学规定。记录手术时间、术中出血量、术中及术后并发症发生情况。术后进行随访3~6个月，超声检查了解结石复发或残余情况。对该手术治疗方法的安全性、可行性及疗效进行评价分析。

35例患者中行单纯病肝切除9例，左半肝切除、胆总管取石引流、胆囊切除23例，左半肝加部分Ⅴ段切除、胆总管取石引流3例。手术均获得成功，平均手术时间184 min，平均出血量341 ml。术后平均住院时间6.5 d，腹腔引流管放置时间2~4 d。术后发生胆漏5例，肝断面脓肿1例，均经引流治愈。无发生出血及膈下脓肿等近、远期并发症。患者均接受术后超声检查随访3~6个月，无肝内结石复发或残余。

腹腔镜下行解剖性肝切除术治疗肝内胆管结石是安全可行的，具有较好的临床应用价值，为肝内胆管结石的治疗提供了新的选择。

To assess the feasibility, safety of laparoscopic anatomical hepatectomy for hepatolithiasis.

Thirty-five patients with hepatolithiasis from the Third Xiangya Hospital of Central South University, March 2008 to March 2012 underwent ultrasound and computed tomography (CT) or magnetic resonance cholangiopancreatography (MRCP) to confirm the position of intrahepatic bile duct stones and situation of liver atrophy and cirrhosis. Laparoscopic anatomical hepatectomy were performed in the 35 patients. Local ethical committee approval had been received and that the informed consent of all participating subjects was obtained. The operative time, intraoperative blood loss, intraoperative and postoperative complications were recorded and the feasibility, safety and treatment effects of laparoscopic anatomical hepatectomy were analyzed.

Nine of the 35 patients underwent partial liver resection and 23 patients underwent left lobe resection, choledocholithotomy drainage and cholecystectomy. Three patients underwent left lobe, partial hepatic segmentⅤresection plus choledocholithotomy drainage. Laparoscopic anatomical hepatectomy was successfully carried out in all the patients. The average operative time was 184 minutes and the blood loss was 341 ml. The mean hospital stay was 6.5 days after surgery. The Peritoneal drainage tube indwelling time was 2 to 4 days. Five patients developed biliary fistula after operation. One patient developed liver section abscess. All patients recovered by sufficient drainage. No complications of hemorrhage and subphrenic abscess occured. All patients were followed up without recurrence of hepatolithiasis and residual stones.

Laparoscopic anatomical hepatectomy in treating hepatolithiasis is feasible, safe and clinically applicable. It can be a new choice for the treatment of hepatolithiasis.