总结腹腔镜肝切除术治疗肝胆管结石临床经验。

回顾性分析2016年3月至2017年3月南昌大学第二附属医院行腹腔镜肝切除术的78例肝胆管结石患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男29例，女49例；年龄20～80岁，中位年龄54岁。患者行腹腔镜肝切除术，对合并胆总管结石或对侧肝胆管结石行胆总管切开、胆道镜探查取石，术中视情况放置T管。

78例腹腔镜肝切除术中，5例中转开腹。行左半肝切除术38例，左外叶切除术33例，右半肝切除术2例，肝Ⅵ段切除5例，联合胆总管切开取石27例，放置T管16例。手术时间（257±63）min，术中出血量（280±72）ml，术中输血6例，术后住院时间（9.3±1.8）d。术后并发症16例，其中肺部感染3例，胆漏5例，术后出血2例，胸腔积液6例，均经保守治疗痊愈，无围手术期死亡。

与传统的开腹肝切除术相比，腹腔镜手术可获得直视放大的近距离清晰视野。在术者熟练掌握腹腔镜技术及严格控制手术适应证的前提下，腹腔镜肝切除术治疗肝胆管结石是安全、可行的。

To summarize clinical experience of laparoscopic hepatectomy in the treatment of hepatolithiasis.

Clinical data of 78 patients with hepatolithiasis undergoing laparoscopic hepatectomy in the Second Affiliated Hospital of Nanchang University from March 2016 to March 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 29 cases were male and 49 female, aged 20-80 years with a median age of 54 years. All patients underwent laparoscopic hepatectomy. Choledocholithotomy and choledochoscopic exploration were performed in patients complicated with choledocholithiasis or hepatolithiasis of the contralateral side. T-tubes were inserted as appropriate during the operation.

Of the 78 patients undergoing laparoscopic hepatectomy, 5 cases were converted to laparotomy, 38 cases underwent left hepatectomy, 33 left lateral lobectomy, 2 right hepatectomy, 5 resection of segment Ⅵ, 27 choledocholithotomy and 16 cases received T-tube placement. The mean operation time was (257±63) min. Intraoperative blood loss was (280±72) ml. 6 cases received intraoperative blood transfusion. Postoperative length of hospital stay was (9.3±1.8) d. 16 patients developed postoperative complications including 3 cases of pulmonary infections, 5 biliary leakage, 2 postoperative bleeding and 6 pleural effusion. All these cases were cured after conservative treatments. No death was observed during the perioperative period.

Compared with the traditional open hepatectomy, laparoscopic hepatectomy can obtain a more explicit and closer visual field under direct, amplifying vision. Laparoscopic hepatectomy is a safe, feasible and effective treatment for hepatolithiasis when surgeons are skilled in laparoscopic and hepatic surgical techniques.