完全腹腔镜与开腹左半肝切除治疗左肝胆管结石的比较

摘要

Objective To evaluate the safety and feasibility of total laparoscopic left hemihepatectomy in patients with left intrahepatic bile duct stones.Methods A retrospective analysis was conducted on clinical data of 57 cases of left hemihepatectomy for left intrahepatic bile duct stones from January 2014 to December 2015, including 27 cases of total laparoscopic left hemihepatectomy and 30 cases of open left hemihepatectomy.The related outcomes of the two groups were compared, which included operation time, intraoperative blood bloss, intraoperative blood transfusion rate, postoperative anal exhaust time, postoperative hospital stay, postoperative complications and postoperative residual stone rate in a week.Results The total laparoscopic group had significantly shorter operation time, less intraoperative blood bloss, lower intraoperative blood transfusion rate, shorter postoperative anal exhaust time and postoperative hospital stay than those in the open group [(339.3±52.6) min vs.(371.5±51.5) min, t=-2.333, P=0.023;(296.3±157.4) ml vs.(435.5±240.8) ml, t=-2.552, P=0.012;14.8% (4/27) vs.40.0% (12/30), X2=4.464, P=0.035;(3.2±0.9) d vs.(4.5±1.0) d, t=-4.896, P=0.000;(8.5±2.5) d vs.(11.3±2.2) d, t=-4.468, P=0.000].No significant differences were detected in the postoperative complication rate and postoperative residual stone rate in a week [22.2% (6/27) vs.46.7% (14/30), X2=3.728, P=0.054;14.8% (4/27) vs.23.3% (7/30), X2=0.662, P=0.416].Conclusions Total laparoscopic left hemihepatectomy for left intrahepatic bile duct stones is safe and feasible.Positive perioperative treatment and appropriate intraoperative management is crucial.%目的 探讨完全腹腔镜左半肝切除治疗左肝胆管结石的安全性和可行性. 方法 回顾性分析2014年1月~2015年12月我院57例因左肝胆管结石行左半肝切除的临床资料,其中完全腹腔镜27例,开腹30例.对比2组手术时间、术中出血量、术中输血率、术后肛门排气时间、术后住院时间、术后并发症和术后1周结石残留率. 结果 与开腹组比较,腹腔镜组手术时间短[(339.3±52.6) min vs.(371.5±51.5) min, t=-2.333,P=0.023],术中出血少[(296.3±157.4) ml vs.(435.5±240.8) ml, t=-2.552,P=0.012],术中输血率低[14.8% (4/27) vs.40.0% (12/30), X2=4.464, P=0.035],术后肛门排气早[(3.2±0.9)d vs.(4.5±1.0) d, t=-4.896,P=0.000],术后住院时间短[(8.5±2.5)d vs.(11.3±2.2)d, t=-4.468,P=0.000],2组术后并发症[22.2% (6/27) vs.46.7% (14/30), X2=3.728, P=0.054]和术后1周结石残留率[14.8% (4/27) vs.23.3% (7/30), X2=0.662, P=0.416]差异无统计学意义. 结论 完全腹腔镜左半肝切除治疗左肝胆管结石安全可行,积极的围手术期治疗和恰当的术中处理非常重要.