腹腔镜与开腹肝切除术洽疗区域型肝胆管结石病的倾向性评分匹配研究

摘要

Objective To investigate the clinical effect of laparoscopic versus open hepatectomy in the treatment of patients with regional hepatolithiasis. Methods A total of 87 patients with regional hepatolithiasis who were admitted to The First People′s Hospital of Xianyang from January 2010 to June 2017 were enrolled. Among these patients,38 underwent laparoscopic hepatectomy(laparoscopic group)and 49 underwent open hepatectomy(open group). Propensity score matching was conducted to balance confounding factors between the two groups and then the perioperative indices were compared between the two groups. The t-test was used for comparison of continuous data between groups,and the chi-square test or Fisher′s exact test was used for comparison of categorical data between groups. Results A total of 27 pairs of patients were matched successfully. There were no significant differences between the two groups in the type of hepatectomy,a com-bination with common bile duct exploration,rate of intraoperative hepatic portal occlusion,time of operation,rate of intraoperative blood transfusion,intraoperative stone clearance rate,total postoperative complications,and incidence of serious complication(all P>0.05). Compared with the open group,the laparoscopic group had significantly lower intraoperative blood loss(126.4 ± 18.7 ml vs 143.2 ± 24.1 ml,t=2.862,P=0.006)and shorter length of hospital stay(11.7 ± 2.3 d vs 13.4 ± 1.9 d,t=2.961,P=0.004). Conclusion Lapa-roscopic hepatectomy has a comparable clinical effect to open hepatectomy in the treatment of regional hepatolithiasis and has the advantages of low intraoperative blood loss and rapid postoperative recovery.%目的 比较腹腔镜与开腹肝切除术治疗区域型肝胆管结石病的临床疗效.方法 选取2010年1月-2017年6月咸阳市第一人民医院收治的87例肝胆管结石病患者,其中38例行腹腔镜肝切除术(腹腔镜组),49例行开腹肝切除术(开腹组).利用倾向性评分匹配,均衡2组患者的混杂因素,比较匹配后的围手术期相关指标.计量资料2组间比较采用t检验,计数资料2组间比较采用χ2检验或Fisher精确检验.结果 共27对患者匹配成功.2组患者的肝切除类型、联合胆总管探查术、术中肝门阻断率、手术时间、术中输血率、术中结石清除率及术后结石清除率、术后总并发症及严重并发症发生率比较,差异均无统计学意义(P值均>0.05).但腹腔镜组患者的手术出血量和住院时间均低于开腹组[(126.4 ± 18.7)ml vs(143.2 ± 24.1)ml;(11.7 ± 2.3)d vs (13.4 ± 1.9)d],差异均有统计学意义(t值分别为2.862、2.961,P值分别为0.006、0.004).结论 腹腔镜肝切除术治疗区域型肝胆管结石病效果与开腹手术相当,且具有术中出血量少、术后恢复快等优势.