| 常贵建,雷文俤,卓信斌,等.Laennec膜理论在肝门部胆管狭窄合并肝内胆管结石手术中的应用[J].安徽医药,2025,29(10):1999-2003. |
| Laennec膜理论在肝门部胆管狭窄合并肝内胆管结石手术中的应用 |
| Application of Laennec membrane theory in the operation of hilar bile duct stricture complicated with intrahepatic bile duct calculus |
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| DOI：10.3969/j.issn.1009-6469.2025.10.017 |
| 中文关键词: 肝内胆管结石 胆管狭窄 肝门 肝切除术 腹腔镜检查 Laennec膜 劈开整形 |
| 英文关键词: Intrahepatic bile duct stones Biliary stenosis Porta hepatis Hepatectomy Laparoscopy Laennec membrane Split shaping |
| 基金项目:福建省自然科学基金项目( 2021J011164) |
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| 中文摘要: |
| 目的探讨肝门部胆管狭窄合并肝内胆管结石的病人，腹腔镜下循 Laennec膜下降肝门板、解除胆道狭窄、通畅引流的可行性和疗效。方法回顾 2021年 6月至 2023年 6月宁德师范学院附属宁德市医院收治的 12例肝门部胆管狭窄合并肝内胆管结石的病人为研究对象，分析临床资料，总结治疗经验。结果 12例病人中男 3例，女 9例，年龄( 55.3±12.5)岁。既往史: 7例病人有胆道手术史， 1例病人有胃大部切除手术史。手术方式: 2例病人因左肝管狭窄行腹腔镜下左半肝切除术； 4例病人因肝方叶肥大及肝门部胆管狭窄，行腹腔镜下肝方叶切除 +肝门部胆管劈开整形 +T管引流术； 5例病人行肝门部胆管劈开整形 +T管引流术； 1例病人行腹腔镜下肝门部胆管整形术，因狭窄范围广、拼合整形困难中转开腹，后行胆肠内引流术。手术时间(330.0±141.1)min，出血量( 152.5±66.8)mL。采用加速康复理念对病人进行围手术期管理。术后发生胆漏 1人，经保持腹腔引流管通畅引流、加强营养支持，保守治疗痊愈。无术后出血、肝功能不全及再次手术病例(术后经 T管窦道取石不计入再次手术病例)。术后住院时间( 11.5±6.4)d。结论肝门部胆管狭窄合并肝内胆管结石的病人，腹腔镜下循 Laennec膜下降肝门板、劈开整形或切除狭窄的胆管及相应的肝叶肝段可以很好地解除肝门部胆管的狭窄、清除肝内胆管结石，近期效果良好。但病人数量少、随访时间较短，劈开整形的胆管会不会再次发生狭窄，远期效果如何尚需要进一步的临床随访观察。 |
| 英文摘要: |
| Objective To investigate the feasibility and efficacy of laparoscopic descent of the hepatic portal plate, relief of biliarystricture and unobstructed drainage in patients with hilar bile duct stenosis and intrahepatic bile duct stones.Methods Twelve pa-tients with hilar bile duct stenosis and intrahepatic bile duct stones admitted to Ningde City Hospital Affiliated to Ningde Normal Uni-versity from June 2021 to June 2023 were reviewed, and the clinical data were analyzed and the treatment experience was summarized.Results Among the 12 patients, 3 were males and 9 were females, aged (55.3 ± 12.5) years. Anamnesis: 7 patients had a history of bil-iary tract surgery, and 1 patient had a history of gastrectomy surgery. Surgical methods: 2 patients underwent laparoscopic left hemi-hepatectomy due to left hepatic duct stenosis, four patients underwent laparoscopic lobectomy + hilar bile duct splitting + T duct drain-age due to hepatic lobe hypertrophy and hilar bile duct stenosis, 5 patients underwent hilar bile duct splitting + T tube drainage, andone patient underwent laparoscopic hilar cholangioplasty and was converted to laparotomy due to wide range of stenosis and difficultyin assembling plastic surgery, followed by biliary and intestinal drainage. The operation time was (330.0 ± 141.1) min, and the bloodloss was (152.5 ± 66.8) mL. The concept of accelerated recovery was used to manage patients perioperatively. One patient had bile leak-age after surgery, and was cured by conservative treatment by keeping the abdominal drainage tube open and draining, and strengthen-ing nutritional support. There were no cases of postoperative hemorrhage, hepatic insufficiency and reoperation (postoperative trans-T-duct sinus stone removal was not included in the reoperation cases). The postoperative hospital stay was (11.5 ± 6.4) days. Conclu. sions For patients with hilar bile duct stenosis complicated with intrahepatic bile duct calculus, laparoscopic descent of the hepaticportal plate through Laennec membrane, split and plastic resection or resection of the narrow bile duct and the corresponding hepatic lobe segments can effectively relieve the stenosis of the hilar bile duct and remove intrahepatic bile duct calculus, with good results inthe near future. However, the number of patients is small and the follow-up time is short, so whether the bile duct will narrow again and what the long-term effect is still needs further clinical follow-up observation. |
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