目的 探讨创面封闭胶在肝胆管结石腹腔镜肝叶切除手术中的应用.方法 将84例肝左外叶肝胆管结石行腹腔镜手术患者随机分为使用创面封闭胶组(治疗组)与对照组.治疗组行腹腔镜胆道探查、左肝外叶切除术,喷涂创面封闭胶方法处理肝断面:对照组则行肝断面大网膜填塞对拢缝合.观察手术时间、术后腹腔引流管引流量、性质、有无胆痿、引流管留置时间、术后肝功能情况、住院时间等指标.结果 治疗组手术时间、转氨酶及胆红素升高幅度、肝功能恢复正常时间、术后引流量、引流液红细胞计数及血红蛋白含量、拔管时间、住院时间明显低于对照组(P＜0.05),发生轻微胆痿2例(占4.7%),无膈下脓肿.对照组共发生胆瘘5例(占11.9%),其中较严重胆瘘3例(占7.1%),膈下脓肿1例.结论 肝胆管结石腹腔镜手术肝创面处理中应用创面封闭胶,可以节省手术时间,减少对肝功能损害,有效减少术后出血、渗出和胆痿的发生,优于腹腔镜常规肝断面处理方法.%Objective To investigate the application of medical obturation glue in patients with hepatolithiasis who underwent laparoscopic hepatectomy. Methods 84 patients with hepatolithiasis of left lateral lobe underwent laparoscopic hepatectomy. These patients were randomly divided into medical obturation glue group (treatment group) and control group. The patients underwent laparoscopic hepatectomy in both groups. Medical obturation glue and omentum filled, conventional suture techniques were used in hepatic cross section in treatment group and control group respectively. Operation time,characteristics of drainage flow, biliary fistula, drainage duration, postoperative liver function test and hospitalization time were observed in the two groups. Results The length of operation, the increasing amplitude of bilirubin and transaminase, the recovery time of liver function, drainage flow, the red blood cell and hemoglobin count in drainage fluid, extubation time and hospitalization time in trail group were significantly lower than that of control group (P < 0.05). Two mild and five biliary fistula were observed in trail group (4.7% ), while five biliary fistula were seen in the control group (11. 9% ) including: three serious biliary fistula (7.1% )and one sub -diaphragm abscess. Conclusion The application of medical obturation glue in hepatic cross section of patients undergoing laparoscopic hepatolobectomy for hepatolithiasis, is better than the traditional method, in terms of saving operation time, decreasing liver injury, blood loss, biliary fistula.
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