腹腔镜与开腹左肝外叶切除联合胆道镜取石治疗左肝内胆管结石的疗效比较  

Effect of laparoscopic vs open left extrahepatic lobectomy combined with choledochoscopy in the treatment of left intrahepatic cholelithiasis.

作　　者：拓婷[1] 王锦江[2] TUO Ting;WANG Jin-jiang(Anorectal Department,Department of General Surgery,Yan'an 716000,Shaanxi,CHINA;Anorectal Department,Yan'an People's Hospital,Yan'an 716000,Shaanxi,CHINA)

机构地区：[1]延安市人民医院肛肠科,陕西延安716000 [2]延安市人民医院普外科,陕西延安716000

出　　处：《海南医学》2020年第20期2640-2643,共4页Hainan Medical Journal

摘　　要：目的探讨腹腔镜与开腹左肝外叶切除联合胆道镜取石治疗左肝内胆管结石的疗效。方法回顾性分析2017年1月至2019年1月期间延安市人民医院收治的72例左肝内胆管结石患者的临床资料,所有患者均接受左肝外叶切除联合胆道镜取石术治疗,将其中37例接受腹腔镜手术治疗者纳入腹腔镜组,35例接受开腹手术治疗者纳入开腹组,比较两组患者的手术时间、术中出血量、术后1 d疼痛程度[视觉模拟评分法(VAS)评分]、肠功能恢复时间、术后住院天数、肝功能[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)等]及并发症发生情况。随访15个月,观察复发情况。结果两组患者的手术时间、术中出血量比较差异均无统计学意义(P>0.05);腹腔镜组患者术后肠道功能恢复时间、术后疼痛VAS评分及术后住院天数分别为(22.3±6.5)h、(4.2±1.3)分、(10.8±2.1)d,明显少于开腹组的(38.6±11.5)h、(6.8±1.9)分、(13.5±3.4)d,并发症发生率为5.41%,明显低于开腹组的22.86%,差异均有统计学意义(P<0.05);术后7 d,两组患者的血清ALT、AST及TBIL均较术前明显降低,差异均有统计学意义(P<0.05),但两组间上述各项指标比较差异均无统计学意义(P>0.05);随访15个月,腹腔镜组复发率为5.41%,与开腹组的2.86%比较差异无统计学意义(P>0.05)。结论腹腔镜左肝外叶切除联合胆道镜取石术治疗左肝外叶胆管结石与开腹相比疗效相当,但腹腔镜术后恢复快,可作为该类疾病的首选治疗方式。Objective To investigate the effect of laparoscopic vs open left lateral lobectomy combined with choledochoscopy in the treatment of left intrahepatic cholelithiasis.Methods From January 2017 to January2019,the clinical data of 72 patients with left intrahepatic cholelithiasis treated in Yan'an People's Hospital were retrospectively analyzed.All patients were treated with left extrahepatic lobectomy and choledochoscopic lithotomy,of which 37 patients received laparoscopic surgery(the laparoscopic group),and 35 patients received open surgery(the open group).The perioperative clinical indicators of the two groups were compared,including operation time,intraoperative blood loss,and the degree of postoperative pain(Visual Analogue Scale[VAS]score),the recovery time of intestinal function,postoperative length of hospital stay,the change of liver function(alanine aminotransferase[ALT],aspartate aminotransferase[AST],total bilirubin[TBIL])and the occurrence of complications.The patients were followed up for 15 months,and the recurrence was observed.Results There was no significant difference between the two groups in operation time and intraoperative bleeding(P>0.05);the recovery time of intestinal function,postoperative VAS score,and postoperative length of hospital stay in laparoscopic group were(22.3±6.5)h,(4.2±1.3)d,(10.8±2.1)d,respectively,which were significantly less than(38.6±11.5)h,(6.8±1.9)d,(13.5±3.4)d in open group(P<0.05);the incidence of complications was 5.41%,significantly lower than 22.86%of the open group(P<0.05).After 7 days,serum ALT,AST,and TBIL of the two groups were significantly lower than those before operation(P<0.05),but there was no significant difference between the two groups(P>0.05).After 15 months of follow-up,the recurrence rate of laparoscopic group was 5.41%,as compared with 2.86%of open group(P>0.05).Conclusion Laparoscopic left extrahepatic lobectomy combined with choledochoscopy for the treatment of left intrahepatic cholelithiasis has the same effect as open left extrahepatic

关 键 词：肝内胆管结石 腹腔镜手术 肝叶切除术 胆道镜趋势 疗效 

分 类 号：R657.42[医药卫生—外科学]