Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Yuexiu, Guangzhou, 510080, Guangdong, People's Republic of China.
Surg Endosc. 2020 Feb;34(2):915-919. doi: 10.1007/s00464-019-06848-1. Epub 2019 Aug 2.
Laparoscopic left lateral sectionectomy (LLS) followed by a biliary tract exploration is used to treat left lateral hepatolithiasis. The purpose of this study was to compare the efficacy of two methods of biliary tract explorations in LLSs: biliary tract exploration through a common bile duct (CBD) incision or through the left lateral hepatic duct (LLHD) stump.
One hundred eight patients were retrospectively analyzed in our hospital from 2009 to 2018. To compare different methods of biliary tract explorations during LLSs, the patients were divided into 2 groups: 36 patients underwent biliary tract exploration through the LLHD stump (LLSS group), and 72 patients underwent biliary tract exploration through the CBD incision (LLSC group). Clinical data on disease characteristics, surgical outcomes, and surgery-related complications were compared between the 2 groups.
Bile duct stones were successfully cleared in all patients. For 2 patients in the LLSS group and 3 patients in the LLSC group, treatment was switched to laparotomy. There were no significant differences in the total operation time (P = 0.09), incidence of bleeding volume (P = 0.33), and bile leakage (P = 0.12) between the two groups. The time of choledochoscopy in the LLSS group was significantly lower than that in the LLSC group (P = 0.03). No bile duct injuries, strictures, recurrent stones, or other adverse events were observed in any patients during follow-up.
Exploration of the biliary tract through the LLHD stump is safe and provides satisfactory results for select patients.
腹腔镜左外叶切除术（LLS）联合胆道探查术用于治疗左外叶肝内胆管结石。本研究旨在比较 LLS 术中两种胆道探查方法的疗效：经胆总管（CBD）切开胆道探查和经左外叶肝管残端（LLHD）胆道探查。
回顾性分析我院 2009 年至 2018 年收治的 108 例患者。为比较 LLS 术中不同胆道探查方法，将患者分为两组：36 例行 LLHD 残端胆道探查（LLSS 组），72 例行 CBD 切开胆道探查（LLSC 组）。比较两组患者的疾病特征、手术结果和手术相关并发症等临床资料。
所有患者胆管结石均成功清除。LLSS 组有 2 例和 LLSC 组有 3 例患者改行开腹手术。两组患者总手术时间（P=0.09）、出血量（P=0.33）和胆漏（P=0.12）发生率差异均无统计学意义。LLSS 组的胆道镜检查时间明显短于 LLSC 组（P=0.03）。随访期间，两组患者均未发生胆管损伤、狭窄、复发性结石等其他不良事件。
经 LLHD 残端探查胆道安全有效，适用于部分患者。
