探讨腹腔镜规则性肝切除治疗肝胆管结石病的技术要点。

回顾性分析2014年2月至2019年9月在皖南医学院弋矶山医院行腹腔镜规则性肝切除的33例肝胆管结石病患者临床资料。患者签署知情同意书，符合医学伦理学规定。其中男19例，女14例；年龄33～76岁，中位年龄60岁。结石分布于Ⅱ、Ⅲ段17例，Ⅱ、Ⅲ、Ⅳ段16例。术前肝功能Child-Pugh分级A级25例，B级8例。采用五孔法腹腔镜肝左外叶切除或左半肝切除，仔细解剖第一肝门，适当游离肝周韧带，断肝平面避开结石，精细切肝，确保保留侧胆管内无结石残留。观察患者手术情况和疗效，并总结技术特点。

所有患者均在腹腔镜下完成手术，无中转开腹。其中肝左外叶切除+胆总管探查取石17例，左半肝切除+胆总管探查取石15例，单纯左半肝切除1例。手术时间中位数319（120～480）min，术中出血量145（50～600）ml，输血4例，输血量450（400～600）ml。术后出血3例，急性胆管炎1例，腹腔感染1例，肝断面胆漏4例。术后住院时间9（6～17）d。

腹腔镜规则性肝切除治疗肝胆管结石病具有自身独特的技术要求，应遵循微创、精准肝切除原则。

To summarize the technical characteristics of regular laparoscopic hepatectomy for hepatolithiasis.

Clinical data of 33 patients with hepatolithiasis who underwent regular laparoscopic hepatectomy in Yijishan Hospital of Wanna Medical College from February 2014 to September 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 19 patients were male and 14 female, aged from 33 to 76 years with a median age of 60 years. Hepatic stones of 17 cases were observed in segment Ⅱ and Ⅲ, and 16 cases in segment Ⅱ, Ⅲ and Ⅳ. 25 cases were classified as Child-Pugh grade A and 8 cases as grade B. Five-port laparoscopic left lateral lobectomy or left hepatectomy was performed, the porta hepatis was carefully dissected, the perihepatic ligament was properly separated, the transected liver plane was made avoiding the stones and the liver was explicitly resected to ensure no residual stones in the bile duct of remnant liver. The surgical condition and efficacy were observed. The technical characteristics were summarized.

All patients completed the laparoscopic surgery, and no patient was converted to open surgery. 17 cases underwent left lateral lobectomy combined with common bile duct exploration, 15 cases of left hepatectomy combined with common bile duct exploration, and 1 case of simple left hepatectomy. The median operation time was 319(120-480) min, the intraoperative blood loss was 145(50-600) ml. 4 cases received blood transfusion with an amount of 450(400-600) ml. Postoperative bleeding occurred in 3 cases, acute cholangitis in 1 case, abdominal infection in 1 case and bile leakage in 4 cases. The length of postoperative hospital stay was 9(6-17) d.

Laparoscopic regular hepatectomy for hepatolithiasis has unique technical requirements, which should be performed with the principle of minimally invasive and precise hepatectomy.