腹腔镜肝切除术治疗肝内胆管结石的临床疗效研究  

Clinical efficacy of hepatolithiasis with laparoscopic hepatectomy

作　　者：王朦 林天宇 丁国平[1] 吴峥嵘[1] 梁霄[1] 曹利平[1] 蒋桂星[1] Wang Meng;Lin Tianyu;Ding Guoping;Wu Zhengrong;Liang Xiao;Cao Liping;Jiang Guixing(Department of Hepatopancreatobiliary Surgery,Affiliated Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,Zhejiang Hangzhou 310000,China;Department of General Surgery,Huaihe Hospital of Henan University,Henan Kaifeng 475000,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院肝胆胰外科,浙江杭州310000 [2]河南大学淮河医院普外科,河南开封475000

出　　处：《腹部外科》2021年第6期427-431,共5页Journal of Abdominal Surgery

摘　　要：目的探讨腹腔镜肝切除术治疗肝内胆管结石的安全性、有效性以及临床应用价值。方法回顾性分析浙江大学医学院附属邵逸夫医院普外科2015年1月至2019年12月收治的肝内胆管结石行肝切除术治疗的208例病人,其中95例病人行开腹肝切除术(open hepatectomy,OH),113例行腹腔镜肝切除术(laparoscopic hepatectomy,LH)。术后随访6~40个月,记录病人术前情况、手术结果、术后情况、随访情况。结果95例行OH病人中,手术时间为(239.9±77.6)min,术中出血(308.9±211.6)mL,术中输血率为21.1%(20/95),切口感染率为15.8%(15/95),术后镇痛药使用时间为(4.1±1.9)d,术后抗生素使用时间为(8.5±5.1)d,术后禁食时间为(3.3±1.7)d,术后下床活动所需时间为(2.5±1.7)d,住院费用为(68932.2±16852.7)元。113例行LH病人中,手术时间为(219.2±68.9)min,术中出血(211.2±205.9)mL,术中输血率为9.7%(11/113),切口感染率为7.1%(8/113),术后镇痛药使用时间为(1.5±0.9)d,术后抗生素使用时间为(4.3±2.7)d,术后禁食时间为(2.4±0.8)d,术后下床活动所需时间为(1.9±1.3)d,住院费用为(56005.9±15376.9)元。以上指标LH与OH比较,差异均有统计学意义(均P<0.05)。两组即时结石清除率、最终结石清除率、结石复发率差异均无统计学意义(均P>0.05)。结论LH作为治疗肝内胆管结石的术式,与OH相比手术时间短、术中出血量少、术中输血率低,切口感染率低,术后镇痛药、抗生素使用时间更短,术后禁食、下床活动所需时间、住院时间更短,住院费用更低。同时,LH即时结石清除率、最终结石清除率及结石复发率与OH相当。Objective To explore the safety,effectiveness and clinical application value of laparoscopic hepatectomy in the treatment of hepatolithiasis.Methods From January 2015 to December 2019,clinical data of 208 hepatolithiasis patients undergoing hepatectomy were reviewed retrospectively.Open hepatectomy(OH,n=95)and laparoscopic hepatectomy(LH,n=113)were performed.During a follow-up period of(6-40)months,preoperative profiles,surgical findings,postoperative outcomes and follow-up results were recorded.Results In OH group,operative duration was(239.9±77.6)min,intraoperative blood loss(308.9±211.6)mL,intraoperative transfusion rate 21.1%(20/95),incision infection rate 15.8%(15/95)and time for postoperative analgesic(4.1±1.9)days,time for postoperative antibiotic(8.5±5.1)days,time for postoperative fasting(3.3±1.7)days,time for ambulation(2.5±1.7)days and hospitalization expenditure(68932.2±16852.7)yuan.In LH group,operative duration was(219.2±68.9)min,intraoperative blood loss(211.2±205.9)mL,intraoperative transfusion rate 9.7%(11/113),incision infection rate 7.1%(8/113),time for postoperative analgesic(1.5±0.9)days,time for postoperative antibiotic(4.3±2.7)days,time for postoperative fasting(2.4±0.8)days,time for ambulation(1.9±1.3)days and hospitalization expenditure(56005.9±15376.9)yuan.No significant inter-group difference existed in immediate/final stone clearance rate or stone recurrence rate.Conclusion As a surgical procedure for the treatment of hepatolithiasis,LH has shorter operative duration,less intraoperative blood loss,lower intraoperative transfusion rate,lower incision infection rate,shorter postoperative analgesic and antibiotic using time,shorter postoperative fasting and ambulation time,shorter hospitalization stay and lower hospitalization expenditure.Also immediate/final stone clearance rate and stone recurrence rate are comparable for OH.

关 键 词：肝内胆管结石 腹腔镜肝切除术 开腹肝切除术 疗效 

分 类 号：R65[医药卫生—外科学]