腹腔镜肝左外叶切除联合胆总管切开取石术治疗肝内外胆管结石疗效  

Laparoscopic left lateral lobectomy combined with choledocholithotomy in treatment of intrahepatic and extrahepatic bile duct stones

作　　者：武玉强[1] 周载平[1] 胡泽民[1] 孙强[1] Wu Yuqiang;Zhou Zaiping;Hu Zemin;Sun Qiang(Department of Hepatobiliary Surgery,Zhongshan Hospital Affiliated to Sun Yat-sen University,Zhongshan 528400,China)

机构地区：[1]中山大学附属中山医院肝胆外科,广东省中山市528400

出　　处：《中华肝脏外科手术学电子杂志》2021年第4期386-389,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省医学科研基金(B2013439)。

摘　　要：目的探讨腹腔镜肝左外叶切除联合胆总管切开取石术治疗肝内外胆管结石的临床疗效。方法回顾性分析2013年1月至2020年10月中山大学附属中山医院收治的186例肝左叶胆管结石合并胆总管结石患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男71例,女115例;年龄33-82岁,中位年龄52岁。根据手术方式不同,将患者分为腔镜组(104例)和开腹组(82例)。比较两组患者围手术期情况和并发症发生情况。两组手术时间、术中出血量等比较采用t检验,并发症发生率等比较采用χ^(2)检验。结果腔镜组平均手术时间(258±26)min,明显长于开腹组的(212±32)min(t=3.512,P<0.05);而术中出血量、术后禁食时间、术后下床时间、术后住院时间分别为(182±14)ml、(1.3±0.6)d、(2.3±0.4)d、(8.5±2.3)d,明显少于开腹组的(260±15)ml、(3.4±0.4)d、(4.2±0.5)d、(12.5±2.7)d(t=-1.894,-2.767,-1.724,-4.156;P<0.05)。腔镜组术后残余结石5例,开腹组4例,差异无统计学意义(χ^(2)=0.125,P>0.05)。腔镜组术后切口感染1例,开腹组5例,差异有统计学意义(χ^(2)=3.972,P<0.05)。结论腹腔镜肝左外叶切除联合胆总管切开取石术治疗肝内外胆管结石创伤小、术后恢复快、安全,可达到与开腹手术相同的疗效。Objective To evaluate the clinical efficacy of laparoscopic left lateral lobectomy combined with choledocholithotomy in the treatment of intrahepatic and extrahepatic bile duct stones.Methods Clinical data of 186 patients with bile duct stones located in the left lobe and common bile duct admitted to Zhongshan Hospital Affiliated to Sun Yat-sen University from January 2013 to October 2020 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,71 patients were male and 115 female,aged from 33 to 82 years with a median age of 52 years.According to different surgical methods,all patients were divided into the laparoscopic group(n=104)and open group(n=82).The perioperative conditions and incidence of postoperative complications were compared between two groups.The operation time and intraoperative blood loss were statistically compared between two groups by t test.The incidence of postoperative complications was compared by Chi-square test.Results The average operation time in laparoscopic group was(258±26)min,significantly longer than(212±32)min in the open group(t=3.512,P<0.05).In laparoscopic group,the intraoperative blood loss,postoperative fasting time,postoperative out-off-bed time and length of postoperative hospital stay were(182±14)ml,(1.3±0.6)d,(2.3±0.4)d and(8.5±2.3)d,significantly less than(260±15)ml,(3.4±0.4)d,(4.2±0.5)d and(12.5±2.7)d in open group(t=-1.894,-2.767,-1.724,-4.156;P<0.05),respectively.In laparoscopic group,5 cases developed residual stones and 4 cases in open group,where no significant difference was observed(χ^(2)=0.125,P>0.05).In laparoscopic group,1 case suffered from postoperative incisional infection,significantly differing from 5 cases in open group(χ^(2)=3.972,P<0.05).Conclusions Laparoscopic left lateral lobectomy combined with choledocholithotomy yields mild trauma,rapid recovery and high safety in the treatment of intrahepatic and extrahepatic bile duct stones,which can achieve

关 键 词：胆结石 腹腔镜 肝切除术 治疗结果 

分 类 号：R657.4[医药卫生—外科学] R657.3[医药卫生—临床医学]